Provider Demographics
NPI:1104272947
Name:G. KEOKI SCANLAN MOISES, LCSW, CSAC, LLC
Entity type:Organization
Organization Name:G. KEOKI SCANLAN MOISES, LCSW, CSAC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SCANLAN
Authorized Official - Last Name:MOISES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC
Authorized Official - Phone:808-728-7346
Mailing Address - Street 1:87-908 KULAUKU ST
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3353
Mailing Address - Country:US
Mailing Address - Phone:808-728-7346
Mailing Address - Fax:
Practice Address - Street 1:87-908 KULAUKU ST
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3353
Practice Address - Country:US
Practice Address - Phone:808-728-7346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty