Provider Demographics
NPI:1093750895
Name:GOLD, MITZI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MITZI
Middle Name:
Last Name:GOLD
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 1:2957 KALAKAUA AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-4650
Mailing Address - Country:US
Mailing Address - Phone:808-926-2052
Mailing Address - Fax:808-732-3707
Practice Address - Street 1:1016 KAPAHULU AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1354
Practice Address - Country:US
Practice Address - Phone:808-737-6277
Practice Address - Fax:808-732-3707
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-663103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55077401Medicaid
HI50315Medicare UPIN
HI55743Medicare ID - Type Unspecified