Provider Demographics
NPI:1447988761
Name:JULIE Y. TAKISHIMA-LACASA, PHD, LLC
Entity type:Organization
Organization Name:JULIE Y. TAKISHIMA-LACASA, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:YURIE
Authorized Official - Last Name:TAKISHIMA-LACASA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-271-7748
Mailing Address - Street 1:819 KAINOA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1737
Mailing Address - Country:US
Mailing Address - Phone:808-271-7748
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-427-2139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI13911190OtherHAWAII MEDICAL ASSURANCE ASSOCIATION
HI00C0374789OtherHAWAII MEDICAL SERVICE ASSOCIATION ONLINE CARE
HI00D0374787OtherHAWAII MEDICAL SERVICE ASSOCIATION
HIU073078OtherUNIVERSITY HEALTH ALLIANCE