Provider Demographics
NPI:1578653663
Name:AU, ALISA H (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:H
Last Name:AU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:H
Other - Last Name:AOKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:87-2116 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3854
Mailing Address - Country:US
Mailing Address - Phone:808-432-3500
Mailing Address - Fax:
Practice Address - Street 1:87-2116 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3854
Practice Address - Country:US
Practice Address - Phone:808-432-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-33711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58876701Medicaid
HI0000263160OtherHMSA BILLING NUMBER
HI58876701Medicaid