Provider Demographics
NPI:1568418135
Name:WITHERS, DEBORAH A (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:WITHERS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-0685
Mailing Address - Country:US
Mailing Address - Phone:978-456-7705
Mailing Address - Fax:978-456-7307
Practice Address - Street 1:54-426 KAPAAU ROAD
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:978-456-7705
Practice Address - Fax:808-209-8034
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI42721041C0700X
MA1069531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4586Medicare ID - Type Unspecified