Provider Demographics
NPI:1033298203
Name:SPINA, LAILA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:
Last Name:SPINA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LAILA
Other - Middle Name:SPINA
Other - Last Name:VALENTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 3805
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96812-3805
Mailing Address - Country:US
Mailing Address - Phone:808-599-7676
Mailing Address - Fax:808-599-7900
Practice Address - Street 1:438 HOBRON LN STE 409
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1229
Practice Address - Country:US
Practice Address - Phone:808-599-7676
Practice Address - Fax:808-599-7900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1157103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPSY-1157OtherPSYCHOLOGY LICENSE