Provider Demographics
NPI:1275881914
Name:MORI-RAPHAEL, JENNILEE (MPH, BSW)
Entity Type:Individual
Prefix:
First Name:JENNILEE
Middle Name:
Last Name:MORI-RAPHAEL
Suffix:
Gender:F
Credentials:MPH, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MAHALANI ST
Mailing Address - Street 2:SUITE 19A
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2521
Mailing Address - Country:US
Mailing Address - Phone:808-244-7467
Mailing Address - Fax:808-242-4762
Practice Address - Street 1:95 MAHALANI ST
Practice Address - Street 2:SUITE 19A
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2521
Practice Address - Country:US
Practice Address - Phone:808-244-7467
Practice Address - Fax:808-242-4762
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker