Provider Demographics
NPI:1033263785
Name:LANSER, ROBERT DUDLEY JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DUDLEY
Last Name:LANSER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 WILI PA LOOP STE 7
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1271
Mailing Address - Country:US
Mailing Address - Phone:808-249-2121
Mailing Address - Fax:808-242-8920
Practice Address - Street 1:1787 WILI PA LOOP STE 7
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1271
Practice Address - Country:US
Practice Address - Phone:808-249-2121
Practice Address - Fax:808-242-8920
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-30661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52823403Medicaid
HIH103986Medicare PIN