Provider Demographics
NPI:1598803900
Name:KANE, TOM (PSYD,LCSW,CSAC,)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:KANE
Suffix:
Gender:M
Credentials:PSYD,LCSW,CSAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1663
Mailing Address - Country:US
Mailing Address - Phone:808-214-5699
Mailing Address - Fax:808-214-5699
Practice Address - Street 1:2599 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1663
Practice Address - Country:US
Practice Address - Phone:808-214-5699
Practice Address - Fax:808-214-5699
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1237431041C0700X
HILCSW34581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical