Provider Demographics
NPI:1750877312
Name:HEPBURN, MAKAHALA (LCSW)
Entity type:Individual
Prefix:
First Name:MAKAHALA
Middle Name:
Last Name:HEPBURN
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 1:1165 NW 45TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6625
Mailing Address - Country:US
Mailing Address - Phone:954-297-8961
Mailing Address - Fax:
Practice Address - Street 1:1903 S CONGRESS AVE STE 340
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6562
Practice Address - Country:US
Practice Address - Phone:954-297-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-07
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL155011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical