Provider Demographics
NPI:1851061824
Name:IVERS, TARYN JOY MAI VALDEZ (LCSW)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:JOY MAI VALDEZ
Last Name:IVERS
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 1:91-1170 MIKOHU ST APT 40C
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4317
Mailing Address - Country:US
Mailing Address - Phone:505-429-5731
Mailing Address - Fax:
Practice Address - Street 1:875 WAIMANU ST STE 610
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5267
Practice Address - Country:US
Practice Address - Phone:808-791-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI47281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical