Provider Demographics
NPI:1043497142
Name:HENNESSEY, RICHARD J (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 LOWREY AVE
Mailing Address - Street 2:H3215
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1800
Mailing Address - Country:US
Mailing Address - Phone:808-372-1219
Mailing Address - Fax:
Practice Address - Street 1:3029 LOWREY AVE
Practice Address - Street 2:H3215
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1800
Practice Address - Country:US
Practice Address - Phone:808-372-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW - 34681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical