Provider Demographics
NPI:1790923423
Name:MOANA, JERRY (MSW)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:MOANA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-1175 PALAHIA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3357
Mailing Address - Country:US
Mailing Address - Phone:808-692-7874
Mailing Address - Fax:
Practice Address - Street 1:601 KAMOKILA BLVD STE 135
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2035
Practice Address - Country:US
Practice Address - Phone:808-692-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker