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NPI Code Detail

MEDICARE: KATHLEEN J GORMAN LICSW

MEDICARE: KATHLEEN J GORMAN LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker7600-123WI
21041C0700XClinical Social Worker13306MN
31041C0700XClinical Social Worker4323HI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1719497800OTHERCADI

General Provider Information

NPI Number : 1063461168
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN J GORMAN LICSW
Provider Business Mailing Address
First Line : 75-5751 KUAKINI HWY
Second Line : STE 203
City : KAILUA KONA
State : HI
Zip : 96740-1753
Country : US
Telephone Number : 808-326-5629
Fax Number : 808-329-9370
Provider Business Practice Location Address
First Line : 75-5751 KUAKINI HWY STE 101A
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-1705
Country : US
Telephone Number : 808-326-5629
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 09/13/2019

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Directions to “ KATHLEEN J GORMAN LICSW” Practice Location

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