Healthcare Provider Details

I. General information

NPI: 1891517850
Provider Name (Legal Business Name): HNL RECOVERY AND PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 PAPAI ST
HONOLULU HI
96821-1945
US

IV. Provider business mailing address

5307 PAPAI ST
HONOLULU HI
96821-1945
US

V. Phone/Fax

Practice location:
  • Phone: 808-489-3012
  • Fax:
Mailing address:
  • Phone: 808-489-3012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ISAIAH MATTHEW MORENO
Title or Position: CLINICAL DIRECTOR
Credential: PSYD
Phone: 808-233-9775