Provider Demographics
NPI:1447598024
Name:KUBOYAMA, KEITH A (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:KUBOYAMA
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S KING ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1956
Mailing Address - Country:US
Mailing Address - Phone:808-351-0830
Mailing Address - Fax:
Practice Address - Street 1:1314 S KING ST
Practice Address - Street 2:SUITE 603
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1956
Practice Address - Country:US
Practice Address - Phone:808-351-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-31751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical