Active NPI
Mary Komomua
- Clinical Social Worker
- Kailua, HI
National Provider Identifier
1245752153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4392
- Practice address
- 1584 Uluhao St
Kailua, HI 96734-4423 - Phone
- (808) 551-7089
- NPI assigned
- Jul 12, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4392 | HI | Primary |
Addresses
Primary practice location
1584 Uluhao St
Kailua, HI 96734-4423
Mailing address
3688 Woodlawn Terrace PL
Honolulu, HI 96822-1475
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4392 | Other | HI | LICENSED CLINICAL SOCIAL WORKER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4392 | HI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1245752153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3688 WOODLAWN TERRACE PL",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968221475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1584 ULUHAO ST",
"city": "KAILUA",
"state": "HI",
"postal_code": "967344423",
"telephone_number": "808-551-7089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMOMUA",
"first_name": "MARY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-12",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "HI",
"license": "4392",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED CLINICAL SOCIAL WORKER",
"identifier": "4392",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kailua, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.