Healthcare Provider Details

I. General information

NPI: 1912833971
Provider Name (Legal Business Name): GARY BROTHERS LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 PAHOA AVE UNIT 10523
HONOLULU HI
96816-8422
US

IV. Provider business mailing address

1001 BISHOP ST STE 2685A
HONOLULU HI
96813-3404
US

V. Phone/Fax

Practice location:
  • Phone: 808-628-8960
  • Fax:
Mailing address:
  • Phone: 808-628-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GARY BROTHERS
Title or Position: OWNER/MEMBER
Credential: LCSW
Phone: 808-628-8960