Provider Demographics
NPI:1154732550
Name:QUAN, MINNIE (LCSW)
Entity type:Individual
Prefix:
First Name:MINNIE
Middle Name:
Last Name:QUAN
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 1:99-644 HOIO ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3403
Mailing Address - Country:US
Mailing Address - Phone:808-754-8488
Mailing Address - Fax:
Practice Address - Street 1:99-644 HOIO ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3403
Practice Address - Country:US
Practice Address - Phone:808-754-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3794104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker