Individual
ROXY A. MICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
162 KINOOLE ST STE 101, HILO, HI 96720-2861
(808) 935-0070
(808) 935-0070
Mailing address
PO BOX 10068, HILO, HI 96721-5068
(808) 935-0070
(808) 935-0070
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 3244
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275942591
TYPE 2 NPI
HI
01
—
H105719
PTAN
HI
Enumeration date
03/13/2015
Last updated
06/09/2015
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