Provider Demographics
NPI:1649201526
Name:WATANABE, KAREN R (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:WATANABE
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 1:1481 S KING ST STE 448
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2605
Mailing Address - Country:US
Mailing Address - Phone:808-949-7759
Mailing Address - Fax:808-942-7191
Practice Address - Street 1:1481 S KING ST STE 448
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2605
Practice Address - Country:US
Practice Address - Phone:808-949-7759
Practice Address - Fax:808-942-7191
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW30521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI24987501Medicaid
HI24987501Medicaid
HI51493Medicare ID - Type UnspecifiedGROUP 51491