Provider Demographics
NPI:1720224579
Name:LIUZZO, SHANNA JALENE (LSW)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:JALENE
Last Name:LIUZZO
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 1:94-144 FARRINGTON HWY STE 115
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1918
Mailing Address - Country:US
Mailing Address - Phone:808-678-3814
Mailing Address - Fax:
Practice Address - Street 1:94-144 FARRINGTON HWY STE 115
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1918
Practice Address - Country:US
Practice Address - Phone:808-678-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1759104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker