Provider Demographics
NPI:1205486370
Name:TIO, SAMANTHA MO-TING (LSW)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MO-TING
Last Name:TIO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:MO-TING
Other - Last Name:TSOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46-078 EMEPELA PL APT G101
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON RD RM B126
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1773104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker