Provider Demographics
NPI:1902981566
Name:JAY, MARTHA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:JAY
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 1:5625A ILEINA LN
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2301
Mailing Address - Country:US
Mailing Address - Phone:808-651-2499
Mailing Address - Fax:808-632-2101
Practice Address - Street 1:3146 AKAHI ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1105
Practice Address - Country:US
Practice Address - Phone:808-632-2010
Practice Address - Fax:808-632-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI33871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical