Provider Demographics
NPI:1275073199
Name:THE VIDEOSYNERGY CONSORTIUM
Entity Type:Organization
Organization Name:THE VIDEOSYNERGY CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-386-3110
Mailing Address - Street 1:1216 YOUNG ST APT 305
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1808
Mailing Address - Country:US
Mailing Address - Phone:808-386-3110
Mailing Address - Fax:
Practice Address - Street 1:1216 YOUNG ST APT 305
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1808
Practice Address - Country:US
Practice Address - Phone:808-386-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-30671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty