Provider Demographics
NPI:1588729354
Name:LEE, LYDIA JINA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:JINA
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:JINA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2040
Mailing Address - Street 2:28 KAMOI STREET SUITE 600
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-2040
Mailing Address - Country:US
Mailing Address - Phone:808-553-5038
Mailing Address - Fax:808-553-5194
Practice Address - Street 1:28 KAMOI STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-553-5038
Practice Address - Fax:808-553-5194
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW33421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical