Provider Demographics
NPI:1033288139
Name:MACIEJEWSKI, SIMONE I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:I
Last Name:MACIEJEWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1540
Mailing Address - Country:US
Mailing Address - Phone:808-636-4789
Mailing Address - Fax:
Practice Address - Street 1:1110 UNIVERSITY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1540
Practice Address - Country:US
Practice Address - Phone:808-636-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-846103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000248690OtherHMSA BILLING NUMBER
HI55731601Medicaid
HI0000248690OtherHMSA BILLING NUMBER
HIH57258Medicare PIN