Lisa KT Jicha, LCSW, CSAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3246 Issued in HI

Practice address

100 Kahelu Ave Ste 232
Mililani, HI 96789-3962

Phone

(808) 625-7448

NPI assigned

Apr 18, 2008

Reactivated

Aug 24, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gina Leong Samala PSYD IncGroup PAC ID 1153303912, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gina Leong Samala, Psy.D, Inc.

  • Clinical Psychologist
  • Mililani, HI
  • NPI 1255517652
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767484800000",
    "number": "1356515498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 893542",
            "city": "MILILANI",
            "state": "HI",
            "postal_code": "967890542",
            "telephone_number": "808-783-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KAHELU AVE STE 232",
            "city": "MILILANI",
            "state": "HI",
            "postal_code": "967893962",
            "telephone_number": "808-625-7448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JICHA",
        "first_name": "LISA",
        "middle_name": "KT",
        "credential": "LCSW, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-18",
        "last_updated": "2026-01-04",
        "certification_date": "2026-01-04",
        "deactivation_date": "2011-01-18",
        "reactivation_date": "2017-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "3246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaelyn Jardine-Feiteira
• Louissa Jasper
• Tammylynn Jenkins
• Ji S Kim (Mauka Family Dental)
• Jasmine Jicha
• Juan Jinete
• JNM Medical LLC
• Ryan Johal, MD
• Aryana Johnson
• Chaunetelle Johnson

• Clinical Social Worker in Mililani, HI
• Providers in Mililani, HI by specialty
• Clinical Social Worker in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.