Basic Information
| Provider Information | |||||||||
| NPI: | 1801920376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAYER | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2338 HAKU HALE ST | ||||||||
| Address2: | |||||||||
| City: | KALAHEO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967419796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082129412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3146 AKAHI ST | ||||||||
| Address2: | |||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086322010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 110201 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.