Provider Demographics
NPI:1366931800
Name:ANTONIO, MALULANI CK (LSW)
Entity type:Individual
Prefix:
First Name:MALULANI
Middle Name:CK
Last Name:ANTONIO
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 1:4340 NANI ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-9039
Mailing Address - Country:US
Mailing Address - Phone:808-754-2012
Mailing Address - Fax:
Practice Address - Street 1:4340 NANI ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-9039
Practice Address - Country:US
Practice Address - Phone:808-754-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2462104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker