Provider Demographics
NPI:1093108029
Name:MARY C. NEEDHAM, PH.D., LLC
Entity Type:Organization
Organization Name:MARY C. NEEDHAM, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-686-2584
Mailing Address - Street 1:1221 KAPIOLANI BLVD PH 38
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3518
Mailing Address - Country:US
Mailing Address - Phone:323-686-2584
Mailing Address - Fax:866-925-4284
Practice Address - Street 1:1221 KAPIOLANI BLVD PH 38
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3518
Practice Address - Country:US
Practice Address - Phone:323-686-2584
Practice Address - Fax:866-925-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1508251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health