Provider Demographics
NPI:1447332531
Name:MANDICH, MAUREEN A (LCSW)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:MANDICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:A
Other - Last Name:O'HAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 KAPIOLANI BLVD FL 16
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4402
Mailing Address - Country:US
Mailing Address - Phone:808-432-7600
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD FL 16
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-432-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-30641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54958701Medicaid
HI0000246439OtherHMSA BILLING NUMBER
HI54958701Medicaid
HIH56131Medicare PIN