Provider Demographics
NPI:1982325429
Name:KASTAN, NICOLE RENEE (LSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:KASTAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 HONAOPIILANI RD G303
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761
Mailing Address - Country:US
Mailing Address - Phone:530-205-5043
Mailing Address - Fax:
Practice Address - Street 1:415 DAIRY RD # E323
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2348
Practice Address - Country:US
Practice Address - Phone:808-518-1619
Practice Address - Fax:844-587-9577
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-2978-0104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker