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General NPI Number Information
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NPI Number | 1558503854
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Entity Type | Individual
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Provider Name | MARK ANDREW GERUM MSW, LCSW, MPH
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Gender | Male
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | TRIPLER ARMY MEDICAL CENTER, 1 JARRETT WHITE ROAD INTENSIVE OUTPATIENT PROGRAM (IOP)
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City | HONOLULU
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State | HI
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Zip | 96859
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Country | US
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Telephone | 808-433-7480
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Fax |
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Provider Business Mailing Address
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Address Line | TRIPLER ARMY MEDICAL CENTER, 1 JARRETT WHITE ROAD INTENSIVE OUTPATIENT PROGRAM (IOP)
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City | APO
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State | AP
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Zip | 96859
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Country | US
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Telephone | 808-433-7480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3480
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License Number State | HI
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