Provider Demographics
NPI:1588899793
Name:MOLLO, LYNNE ROSE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:ROSE
Last Name:MOLLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LYNNE
Other - Middle Name:ROSE-MOLLO
Other - Last Name:BRAUHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1721
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749
Mailing Address - Country:US
Mailing Address - Phone:808-938-4393
Mailing Address - Fax:
Practice Address - Street 1:15-1463 AWA AVE
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:808-938-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
HIHI-39781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor