| Lee Katsumoto Lacerdo, Llc | |
|
94-1036 Waipio Uka St Ste 109 Waipahu HI 96797-4050 | |
| (808) 291-2634 | |
| Not Available |
| Full Name | Lee Katsumoto Lacerdo, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 94-1036 Waipio Uka St Ste 109, Waipahu, Hawaii |
| Authorized Official Name and Position | Lee Lacerdo (OWNER) |
| Authorized Official Contact | 8082912634 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lee Katsumoto Lacerdo, Llc Po Box 1570 Pearl City HI 96782-8570 Ph: (808) 291-2634 | Lee Katsumoto Lacerdo, Llc 94-1036 Waipio Uka St Ste 109 Waipahu HI 96797-4050 Ph: (808) 291-2634 |
| NPI Number | 1659080364 |
|---|---|
| Provider Enumeration Date | 11/21/2022 |
| Last Update Date | 11/21/2022 |
| Certification Date | 11/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659080364 | NPI | - | NPPES |
| 744129 | Medicaid | HI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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