Provider Demographics
NPI:1467770313
Name:PISKURA, GRETCHEN (LCSW)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:PISKURA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 LAMALOA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2535
Mailing Address - Country:US
Mailing Address - Phone:808-282-0939
Mailing Address - Fax:
Practice Address - Street 1:3255 LAMALOA PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2535
Practice Address - Country:US
Practice Address - Phone:808-282-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-35081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical