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General NPI Number Information
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NPI Number | 1679224265
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Entity Type | Organization
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Legal Business Name | GERALD L COFFEE LCSW LLC
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1221 KAPIOLANI BLVD PH 50
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City | HONOLULU
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State | HI
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Zip | 96814-3518
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Country | US
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Telephone | 88-260-9893
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Fax | 808-748-0433
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Provider Business Mailing Address
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Address Line | 1221 KAPIOLANI BLVD PH 50
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City | HONOLULU
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State | HI
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Zip | 96814-3518
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Country | US
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Telephone | 88-260-9893
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Fax | 808-748-0433
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Authorized Official
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Title or Position | OWNER
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Name | JERRY L COFFEE
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Credential | LCSW
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Telephone | 808-382-9185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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