Provider Demographics
NPI:1689074130
Name:TAIRA, WESLEY Y (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:Y
Last Name:TAIRA
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 1:545 MANANAI PL APT U
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5316
Mailing Address - Country:US
Mailing Address - Phone:808-738-6502
Mailing Address - Fax:
Practice Address - Street 1:545 MANANAI PL APT U
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-5316
Practice Address - Country:US
Practice Address - Phone:808-738-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 39641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical