Provider Demographics
NPI:1699080168
Name:MANGINDIN, ALEXANDER LIMJOCO (LICSW)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:LIMJOCO
Last Name:MANGINDIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HINANO WAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5547
Mailing Address - Country:US
Mailing Address - Phone:719-337-4941
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE ROAD TAMC
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-5000
Practice Address - Country:US
Practice Address - Phone:808-433-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3035841041C0700X
TN43081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1OtherMEDDAC