Provider Demographics
NPI:1447407135
Name:KEALOHA, LISA R (MSW)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:R
Last Name:KEALOHA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-188 KIPAPA DR APT 75
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1170
Mailing Address - Country:US
Mailing Address - Phone:808-223-1039
Mailing Address - Fax:
Practice Address - Street 1:3627 KILAUEA AVE # 101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2317
Practice Address - Country:US
Practice Address - Phone:808-675-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker