Active NPI
Ashley C Petitt, LCSW
- Clinical Social Worker
- Kailua, HI
National Provider Identifier
1720664360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-4559
- Practice address
- 364A1 Olomana St
Kailua, HI 96734 - Phone
- (571) 426-8640
- NPI assigned
- Mar 23, 2021
- Sex
- Female
- Sole proprietor
- No
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 | LCSW-4559 | HI | Primary |
Addresses
Primary practice location
364A1 Olomana St
Kailua, HI 96734
Mailing address
364A1 Olomana St
Kailua, HI 96734
Phone (571) 426-8640
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-4559 | HI | MD | Clinical Social Worker |
| 14680 | SC | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616457600000",
"number": "1720664360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "364A1 OLOMANA ST",
"city": "KAILUA",
"state": "HI",
"postal_code": "96734",
"telephone_number": "571-426-8640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "364A1 OLOMANA ST",
"city": "KAILUA",
"state": "HI",
"postal_code": "96734",
"telephone_number": "571-426-8640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETITT",
"first_name": "ASHLEY",
"middle_name": "C",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-23",
"last_updated": "2021-03-23",
"certification_date": "2021-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "HI",
"license": "LCSW-4559",
"primary": true
}
],
"identifiers": [],
"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 Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.