Provider Demographics
NPI:1689007544
Name:BARRA, DEBRA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:BARRA
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 1:87-3183 AMA RD
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-8716
Mailing Address - Country:US
Mailing Address - Phone:808-895-5032
Mailing Address - Fax:
Practice Address - Street 1:77-6425 KUAKINI HWY
Practice Address - Street 2:
Practice Address - City:KAULUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-895-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1041C0700X
HILCSW 39061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical