Provider Demographics
NPI:1700904117
Name:WILLIAMS, GWEN (MSW, LCSW)
Entity Type:Individual
Prefix:PROF
First Name:GWEN
Middle Name:
Last Name:WILLIAMS
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:PO BOX 61532
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96839-1532
Mailing Address - Country:US
Mailing Address - Phone:808-375-1746
Mailing Address - Fax:808-833-1317
Practice Address - Street 1:1592 ALA MAHAMOE ST # A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1765
Practice Address - Country:US
Practice Address - Phone:808-375-1746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI31181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI09302-1OtherHMSA