Provider Demographics
NPI:1104372721
Name:COWAN, REBECCA (PSYD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 BISHOP ST
Mailing Address - Street 2:SUITE 1510
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2810
Mailing Address - Country:US
Mailing Address - Phone:808-284-6334
Mailing Address - Fax:
Practice Address - Street 1:1164 BISHOP ST
Practice Address - Street 2:SUITE 1510
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2810
Practice Address - Country:US
Practice Address - Phone:808-284-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1448103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical