Basic Information
Provider Information
NPI: 1003142720
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRACHTE
FirstName: KATE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 915 ALIAMANU PL
Address2:  
City: HONOLULU
State: HI
PostalCode: 968182853
CountryCode: US
TelephoneNumber: 6082253936
FaxNumber:  
Practice Location
Address1: 91-2301 OLD FT WEAVER RD
Address2:  
City: EWA BEACH
State: HI
PostalCode: 967063602
CountryCode: US
TelephoneNumber: 8086718511
FaxNumber: 8086772570
Other Information
ProviderEnumerationDate: 10/30/2009
LastUpdateDate: 10/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X1795HIY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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