Provider Demographics
NPI:1679646590
Name:TERUYA, DUSTIN KEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:KEN
Last Name:TERUYA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 KAPAHULU AVE
Mailing Address - Street 2:#A-319
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1196
Mailing Address - Country:US
Mailing Address - Phone:808-791-9350
Mailing Address - Fax:
Practice Address - Street 1:277 OHUA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3643
Practice Address - Country:US
Practice Address - Phone:808-791-9350
Practice Address - Fax:808-791-9338
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI32731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
101426Medicare UPIN
101426Medicare ID - Type Unspecified