Healthcare Provider Details

I. General information

NPI: 1871265892
Provider Name (Legal Business Name): JENNA FAY DEVORE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA FAY BROCIOUS N/A

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD STE 1114
HONOLULU HI
96814-4406
US

IV. Provider business mailing address

87-153 KIMO ST
WAIANAE HI
96792-3141
US

V. Phone/Fax

Practice location:
  • Phone: 808-850-0407
  • Fax:
Mailing address:
  • Phone: 808-850-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0906011629
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-5334-0
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: