Provider Demographics
NPI:1598390502
Name:CUSHMAN, LAURA DAWN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DAWN
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 N KAINALU DR APT A
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5851
Mailing Address - Country:US
Mailing Address - Phone:503-407-2470
Mailing Address - Fax:
Practice Address - Street 1:1193 MOKAPU RD
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-5010
Practice Address - Country:US
Practice Address - Phone:808-365-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI40691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical