Provider Demographics
NPI:1578832028
Name:MIRANDA-OME, SONJA (LCSW)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:MIRANDA-OME
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 1:367 PALIKU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2351
Mailing Address - Country:US
Mailing Address - Phone:808-497-1944
Mailing Address - Fax:808-395-7291
Practice Address - Street 1:367 PALIKU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-2351
Practice Address - Country:US
Practice Address - Phone:808-497-1944
Practice Address - Fax:808-395-7291
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1041C0T00XOtherKAISER PERMANENTE
HI1041C0T00XOtherHAWAII MEDICAL ASSOCIATION
HI1041C0T00XOtherHAWAII MEDICAL SERVICE ASSOCIATION
HI1041C0T00XOtherHAWAII MEDICAL ASSURANCE ASSOCIATION