Provider Demographics
NPI:1891136032
Name:TANG, MARY (LSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TANG
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 1:94-408 AKOKI ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2733
Mailing Address - Country:US
Mailing Address - Phone:808-676-5584
Mailing Address - Fax:808-676-5587
Practice Address - Street 1:94-408 AKOKI ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2733
Practice Address - Country:US
Practice Address - Phone:808-676-5584
Practice Address - Fax:808-676-5587
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-2058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker