Healthcare Provider Details

I. General information

NPI: 1568120780
Provider Name (Legal Business Name): TAJANAY SHARRON-MARIE KEATON-CHESSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N VINEYARD BLVD STE A325
HONOLULU HI
96817-3938
US

IV. Provider business mailing address

PO BOX 235292
HONOLULU HI
96823-3504
US

V. Phone/Fax

Practice location:
  • Phone: 802-227-2794
  • Fax:
Mailing address:
  • Phone: 802-227-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18308
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018397
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5367-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: