Provider Demographics
NPI:1861635021
Name:ROSEN, CARRIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:ROSEN
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 1:1441 KAPIOLANI BLVD FL 16
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4402
Mailing Address - Country:US
Mailing Address - Phone:808-432-7600
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD FL 16
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-432-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-34811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000284893OtherHMSA BILLING NUMBER
HI63189702Medicaid
HIBU666ZMedicare PIN