Provider Demographics
NPI:1376151076
Name:LEWIS, BRENNA KUUPILIALOHA
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:KUUPILIALOHA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 KEEAUMOKU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3001
Mailing Address - Country:US
Mailing Address - Phone:808-521-4357
Mailing Address - Fax:
Practice Address - Street 1:2848 PARK ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1157
Practice Address - Country:US
Practice Address - Phone:808-595-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-19
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker