Provider Demographics
NPI:1003947250
Name:SLATER, SHAWN R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:R
Last Name:SLATER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1341
Mailing Address - Street 2:14-803 SEAVIEW RD
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-1341
Mailing Address - Country:US
Mailing Address - Phone:808-965-5349
Mailing Address - Fax:808-965-5036
Practice Address - Street 1:14-803 SEAVIEW RD
Practice Address - Street 2:NANAWALE ESTATES
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-1341
Practice Address - Country:US
Practice Address - Phone:808-965-5349
Practice Address - Fax:808-965-5036
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI33311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical