Active NPI
Elijah Davenport
- Clinical Social Worker
- Honolulu, HI
National Provider Identifier
1508132572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-4774
- Practice address
- 615 Piikoi St
Suite 203
Honolulu, HI 96814-3116 - Phone
- (808) 589-1829
- Fax
- (808) 589-2610
- NPI assigned
- Mar 23, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-4774 | HI | Primary |
Addresses
Primary practice location
615 Piikoi St
Suite 203
Honolulu, HI 96814-3116
Mailing address
PO Box 22922
Honolulu, HI 96823-2922
Phone (808) 450-4344
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-4774 | HI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hale Kipa, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Ewa Beach, HI
- NPI 1164627246
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704240000000",
"number": "1508132572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22922",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968232922",
"telephone_number": "808-450-4344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 PIIKOI ST",
"address_2": "SUITE 203",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968143116",
"telephone_number": "808-589-1829",
"fax_number": "808-589-2610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVENPORT",
"first_name": "ELIJAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-23",
"last_updated": "2024-01-03",
"certification_date": "2024-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "HI",
"license": "LCSW-4774",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.