Provider Demographics
NPI:1407300833
Name:DEGUZMAN, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:SAPPERSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1822 PUNAHOU ST APT 12
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3344
Mailing Address - Country:US
Mailing Address - Phone:808-265-6463
Mailing Address - Fax:
Practice Address - Street 1:1822 KEEAUMOKU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3001
Practice Address - Country:US
Practice Address - Phone:808-527-4947
Practice Address - Fax:808-527-4949
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-46421041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical