Provider Demographics
NPI:1689343378
Name:PETROVICH, SHEYANNE L (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SHEYANNE
Middle Name:L
Last Name:PETROVICH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59-779 ALAPIO RD
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9514
Mailing Address - Country:US
Mailing Address - Phone:541-589-2987
Mailing Address - Fax:
Practice Address - Street 1:1632 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2065
Practice Address - Country:US
Practice Address - Phone:808-589-2367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2802104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker