Healthcare Provider Details

I. General information

NPI: 1699871392
Provider Name (Legal Business Name): PATRICIA J. NEAL L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MAIN ST #518
WAILUKU HI
96793-1654
US

IV. Provider business mailing address

PO BOX 957
MAKAWAO HI
96768-0957
US

V. Phone/Fax

Practice location:
  • Phone: 808-280-3848
  • Fax:
Mailing address:
  • Phone: 808-280-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3212
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: