Provider Demographics
NPI:1831369461
Name:KALANI, JACQUELINE M (LCSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:M
Last Name:KALANI
Suffix:
Gender:F
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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0753
Mailing Address - Country:US
Mailing Address - Phone:808-328-2136
Mailing Address - Fax:
Practice Address - Street 1:92-1657 COCONUT DR
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:HI
Practice Address - Zip Code:96704
Practice Address - Country:US
Practice Address - Phone:808-328-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI33611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1041C0700XOtherTAXONOMY