Provider Demographics
NPI:1134126972
Name:WEISMAN, GARY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:WEISMAN
Suffix:
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 1:1314 S KING ST
Mailing Address - Street 2:#603
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1956
Mailing Address - Country:US
Mailing Address - Phone:808-382-4973
Mailing Address - Fax:808-833-5060
Practice Address - Street 1:1314 S KING ST
Practice Address - Street 2:#603
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1956
Practice Address - Country:US
Practice Address - Phone:808-382-4973
Practice Address - Fax:808-833-5060
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 30041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HILCSW 3004OtherLICENSED CLINICAL SOCIAL