Provider Demographics
NPI:1699871392
Name:NEAL, PATRICIA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:J
Last Name:NEAL
Suffix:
Gender:F
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 957
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0957
Mailing Address - Country:US
Mailing Address - Phone:808-280-3848
Mailing Address - Fax:
Practice Address - Street 1:2200 MAIN ST
Practice Address - Street 2:#518
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1654
Practice Address - Country:US
Practice Address - Phone:808-280-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI32121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55881901Medicaid
HI55881900OtherALOHA CARE QUEST
HI55881901Medicaid