Provider Demographics
NPI:1528101276
Name:LUNDQUIST, BEVERLY ANN (MSW)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 WILI PA LOOP
Mailing Address - Street 2:SUITE NO. 8
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1280
Mailing Address - Country:US
Mailing Address - Phone:808-249-2289
Mailing Address - Fax:808-249-0440
Practice Address - Street 1:1787 WILI PA LOOP
Practice Address - Street 2:SUITE NO. 8
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1280
Practice Address - Country:US
Practice Address - Phone:808-249-2289
Practice Address - Fax:808-249-0440
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 30221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical