Provider Demographics
NPI:1245633833
Name:PENNER, MARILOU (MSW LCSW)
Entity type:Individual
Prefix:
First Name:MARILOU
Middle Name:
Last Name:PENNER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 KAUPAKALUA RD
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5239
Mailing Address - Country:US
Mailing Address - Phone:808-269-7411
Mailing Address - Fax:
Practice Address - Street 1:1111 KAUPAKALUA RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5239
Practice Address - Country:US
Practice Address - Phone:808-269-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI39591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical