Provider Demographics
NPI:1477605798
Name:EAGER, BEVERLY (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:
Last Name:EAGER
Suffix:
Gender:F
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:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-5682
Mailing Address - Country:US
Mailing Address - Phone:808-651-9000
Mailing Address - Fax:808-651-9000
Practice Address - Street 1:2970 KELE ST
Practice Address - Street 2:SUITE #109
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1803
Practice Address - Country:US
Practice Address - Phone:808-651-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-32911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical