Provider Demographics
NPI:1740820026
Name:MERRIAM, KATHLEEN RHOADS (LCSW, CSAC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RHOADS
Last Name:MERRIAM
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-675 LULUKU RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1857
Mailing Address - Country:US
Mailing Address - Phone:808-561-4896
Mailing Address - Fax:
Practice Address - Street 1:WIINDWARD OAHU TREATMENT SERVICES SECTION
Practice Address - Street 2:45-691 KEAAHALA ROAD, BLDG. F
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-233-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1981-18101YA0400X
HI4418101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health