Provider Demographics
NPI:1609211770
Name:HIPPOLITE, ANDRE P (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:P
Last Name:HIPPOLITE
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 1:1500 S BERETANIA ST
Mailing Address - Street 2:402
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1932
Mailing Address - Country:US
Mailing Address - Phone:808-945-3690
Mailing Address - Fax:808-945-2811
Practice Address - Street 1:1500 S BERETANIA ST
Practice Address - Street 2:402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1932
Practice Address - Country:US
Practice Address - Phone:808-945-3690
Practice Address - Fax:808-945-2811
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI37331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical