Provider Demographics
NPI:1467162214
Name:SHIBATA, LESLEY T (MSW)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:T
Last Name:SHIBATA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:T
Other - Last Name:SHIBATA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:3627 KILAUEA AVE # 401
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2317
Mailing Address - Country:US
Mailing Address - Phone:808-733-9371
Mailing Address - Fax:
Practice Address - Street 1:3627 KILAUEA AVE # 401
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2317
Practice Address - Country:US
Practice Address - Phone:808-733-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health