Healthcare Provider Details

I. General information

NPI: 1265235576
Provider Name (Legal Business Name): JOSHUA ANTHONY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27-714 0LD ONOMEA RD
PEPEEKEO HI
96783
US

IV. Provider business mailing address

PO BOX 831104
PEPEEKEO HI
96783-1071
US

V. Phone/Fax

Practice location:
  • Phone: 808-937-0646
  • Fax:
Mailing address:
  • Phone: 808-937-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-5320-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: