Provider Demographics
NPI:1922273325
Name:COFFEE, GERALD LENORD (LCSW)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:LENORD
Last Name:COFFEE
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 1:4068 ROUND TOP DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-5019
Mailing Address - Country:US
Mailing Address - Phone:808-499-7340
Mailing Address - Fax:808-791-6186
Practice Address - Street 1:606 CORAL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5135
Practice Address - Country:US
Practice Address - Phone:808-499-7340
Practice Address - Fax:808-791-6186
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI30171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI101486Medicare PIN