Provider Demographics
NPI:1770963696
Name:DWYER, TIMOTHY EDWARD X (LCSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:DWYER
Suffix:X
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 1:155 N BERETANIA ST APT E 601
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4781
Mailing Address - Country:US
Mailing Address - Phone:808-536-3974
Mailing Address - Fax:808-537-6344
Practice Address - Street 1:155 N BERETANIA ST APT E 601
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4781
Practice Address - Country:US
Practice Address - Phone:808-536-3974
Practice Address - Fax:808-537-6344
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI37771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical