Provider Demographics
NPI:1609192079
Name:BREWERTON, ELLEN WOLFE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:WOLFE
Last Name:BREWERTON
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 1:88 HAWEA PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7148
Mailing Address - Country:US
Mailing Address - Phone:808-572-5664
Mailing Address - Fax:
Practice Address - Street 1:88 HAWEA PL
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7148
Practice Address - Country:US
Practice Address - Phone:808-572-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI30981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical