Provider Demographics
NPI:1740299031
Name:YAMAMOTO, CHARLENE L (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:L
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:Y L
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1221 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 345
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3503
Mailing Address - Country:US
Mailing Address - Phone:808-737-2523
Mailing Address - Fax:808-737-1208
Practice Address - Street 1:1221 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 345
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3503
Practice Address - Country:US
Practice Address - Phone:808-737-2523
Practice Address - Fax:808-737-1208
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-30141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0232627OtherHMSA BILLING NUMBER
HI00C0232623OtherHMSA SOLE PROVIDER
HI00B0232625OtherHMA,INC
HI55094801Medicaid
HIQ09215Medicare UPIN
HIH56264Medicare PIN