Provider Demographics
NPI:1093840894
Name:DR SUSAN HALL INC
Entity Type:Organization
Organization Name:DR SUSAN HALL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:808-394-6206
Mailing Address - Street 1:PO BOX 26049
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-6049
Mailing Address - Country:US
Mailing Address - Phone:808-394-6206
Mailing Address - Fax:808-394-6207
Practice Address - Street 1:4566 OHIA ST
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1646
Practice Address - Country:US
Practice Address - Phone:808-651-4860
Practice Address - Fax:808-822-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY377103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52102205Medicaid
HI00F0235942OtherHAWAII MEDICAL SVC ASSN
HI00F0235942OtherHAWAII MEDICAL SVC ASSN
55456Medicare ID - Type Unspecified