Provider Demographics
NPI:1053562728
Name:STAMM, LESLEY ADACHI (LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:ADACHI
Last Name:STAMM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-1155 MAKAMAE ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3122
Mailing Address - Country:US
Mailing Address - Phone:808-306-0629
Mailing Address - Fax:
Practice Address - Street 1:45-1155 MAKAMAE ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3122
Practice Address - Country:US
Practice Address - Phone:808-306-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI34881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000OtherLICENSED CLINICAL SOCIAL WORKER