Healthcare Provider Details

I. General information

NPI: 1780746016
Provider Name (Legal Business Name): KATHLEEN ANN MCLEOD BCBA, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN MCLEOD ASAHAN LCSW

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 GREEN ST
HONOLULU HI
96813-2119
US

IV. Provider business mailing address

PO BOX 23337
HONOLULU HI
96823-3337
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-8188
  • Fax: 808-524-1021
Mailing address:
  • Phone: 808-386-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3290
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number41
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: