Healthcare Provider Details

I. General information

NPI: 1356767743
Provider Name (Legal Business Name): PHILIPPE GUEDJ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-845 POOKELA ST
KANEOHE HI
96744-5700
US

IV. Provider business mailing address

45-845 POOKELA ST
KANEOHE HI
96744-5700
US

V. Phone/Fax

Practice location:
  • Phone: 808-236-2600
  • Fax:
Mailing address:
  • Phone: 808-236-2600
  • Fax: 808-236-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW - 3956
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: