Provider Demographics
NPI:1487632410
Name:MIYASATO-CRAWFORD, MERNAL FUMI (LSW)
Entity Type:Individual
Prefix:
First Name:MERNAL
Middle Name:FUMI
Last Name:MIYASATO-CRAWFORD
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 1:1 JARRETT WHITE RD
Mailing Address - Street 2:SOCIAL WORK DEPT.
Mailing Address - City:TAMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-2771
Mailing Address - Fax:808-433-1557
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:SOCIAL WORK DEPT.
Practice Address - City:TAMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-2771
Practice Address - Fax:808-433-1557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-152104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker