Basic Information
| Provider Information | |||||||||
| NPI: | 1912498924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CISTERNAS | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | BIBI | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BIBI | ||||||||
| OtherFirstName: | SHARON | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6600 KALANIANAOLE HWY STE 225 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968251281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083942800 | ||||||||
| FaxNumber: | 8083942826 | ||||||||
| Practice Location | |||||||||
| Address1: | 6600 KALANIANAOLE HWY STE 225 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083942800 | ||||||||
| FaxNumber: | 8083942826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2018 | ||||||||
| LastUpdateDate: | 09/06/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | HI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 3938 | HI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.