Individual
DR. BLOSSOM IWALANI FONOIMOANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, MSW, LSW
Contact information
Practice address
604 MAUNALOA HWY, #C, KAUNAKAKAI, HI 96748-0130
(808) 560-3653
(808) 560-3385
Mailing address
56-660 KAMEHAMEHA HWY, KAHUKU, HI 96731-2210
(808) 293-7555
(808) 293-7196
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-1524
HI
104100000X
Social Worker
LSW 1557
HI
1041C0700X
Clinical Social Worker
LCSW-3658
HI
Other
Enumeration date
12/02/2008
Last updated
09/27/2018
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