Healthcare Provider Details

I. General information

NPI: 1205086626
Provider Name (Legal Business Name): TERILYN Y. KELIINOI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TERILYN ALLEN

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N. KUAKINI STREET SUITE #308
HONOLULU HI
96817
US

IV. Provider business mailing address

321 N. KUAKINI STREET SUITE #308
HONOLULU HI
96817
US

V. Phone/Fax

Practice location:
  • Phone: 808-440-6852
  • Fax: 808-440-6878
Mailing address:
  • Phone: 808-440-6852
  • Fax: 808-440-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1720
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3643
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW3643
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: