| Doctor Name: | MS. MARIBETH THEISEN |
| NPI Number: | 1053471409 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW |
| License Number: | LCSW 3319 |
| Business Practice Address: | 105 Kauhaa Street Kihei, HI - 96753 |
| Business Phone Number: | 8082692923 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1442, KIHEI |
| State: | HI |
| Postal Code: | 96753 |
| Phone Number: | 8082692923 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 09/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW 3319 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |