Provider Demographics
NPI:1316719453
Name:MACARAEG, JETHRO TANGONAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:JETHRO
Middle Name:TANGONAN
Last Name:MACARAEG
Suffix:
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:PO BOX 235192
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3503
Mailing Address - Country:US
Mailing Address - Phone:808-258-7438
Mailing Address - Fax:
Practice Address - Street 1:2527 WAOLANI AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1361
Practice Address - Country:US
Practice Address - Phone:808-480-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3114104100000X
HILCSW-52681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker