Provider Demographics
NPI:1083775431
Name:EWING, CHERI ANN (PHD)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:ANN
Last Name:EWING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-0958
Mailing Address - Country:US
Mailing Address - Phone:808-743-5358
Mailing Address - Fax:
Practice Address - Street 1:1847 S KIHEI RD STE 205
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7939
Practice Address - Country:US
Practice Address - Phone:808-280-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20533103TC0700X
HIPSY363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
29751OtherHMSA
HI02660802Medicaid
HI0000TCBQPMedicare ID - Type Unspecified