Healthcare Provider Details

I. General information

NPI: 1699960237
Provider Name (Legal Business Name): JARED DANIEL GERBER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68-051 AKULE ST APT 206
WAIALUA HI
96791-9405
US

IV. Provider business mailing address

PO BOX 654
WAIALUA HI
96791-0654
US

V. Phone/Fax

Practice location:
  • Phone: 808-429-3678
  • Fax:
Mailing address:
  • Phone: 808-429-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3139
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: