Provider Demographics
NPI:1053917161
Name:KIELBASA, ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:KIELBASA
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 1:87-680 HAKIMO RD
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3510
Mailing Address - Country:US
Mailing Address - Phone:808-349-7540
Mailing Address - Fax:
Practice Address - Street 1:87-680 HAKIMO RD
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3510
Practice Address - Country:US
Practice Address - Phone:808-349-7540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI45841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical