Provider Demographics
NPI:1982748182
Name:TESTER, COLLEEN M (LCSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:M
Last Name:TESTER
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 1:698 MILILANI PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9361
Mailing Address - Country:US
Mailing Address - Phone:808-891-0136
Mailing Address - Fax:808-891-0136
Practice Address - Street 1:135 S WAKEA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1385
Practice Address - Country:US
Practice Address - Phone:808-871-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-30941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000237776OtherHAWAII MEDICAL SERVICE AS
HI542606-01Medicaid
HI56846Medicare ID - Type Unspecified