Provider Demographics
NPI:1700515335
Name:PESANKA, STEVEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:PESANKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KANOELEHUA AVE
Mailing Address - Street 2:PMB-347
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-743-5024
Mailing Address - Fax:
Practice Address - Street 1:1555 WAILUKU DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1245
Practice Address - Country:US
Practice Address - Phone:808-743-5024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-47801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical