Provider Demographics
NPI:1114075520
Name:FITZGERALD, JANET ROBINSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ROBINSON
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:ELLEN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDM
Mailing Address - Street 1:1615 MAHANI LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2831
Mailing Address - Country:US
Mailing Address - Phone:808-386-8630
Mailing Address - Fax:808-845-5498
Practice Address - Street 1:1615 MAHANI LOOP
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2831
Practice Address - Country:US
Practice Address - Phone:808-386-8630
Practice Address - Fax:808-845-5498
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-642103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI252536OtherHMSA PROVIDER NUMBER