Provider Demographics
NPI:1477660686
Name:UEHARA, SUSAN M (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:UEHARA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-929 MAHIKU PL
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1151
Mailing Address - Country:US
Mailing Address - Phone:808-449-0175
Mailing Address - Fax:
Practice Address - Street 1:750 SIGNER BOULEVARD
Practice Address - Street 2:BLDG 554
Practice Address - City:HICKAM AFB
Practice Address - State:HI
Practice Address - Zip Code:96853-5399
Practice Address - Country:US
Practice Address - Phone:808-449-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical