Provider Demographics
NPI:1326217241
Name:ALCISTO, JAY CASUPANG (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:CASUPANG
Last Name:ALCISTO
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 1:459 PATTERSON RD # 116
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1522
Mailing Address - Country:US
Mailing Address - Phone:808-433-0778
Mailing Address - Fax:808-433-0395
Practice Address - Street 1:459 PATTERSON RD # 116
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-0778
Practice Address - Fax:808-433-0395
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI37501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI3750OtherLCSW