Provider Demographics
NPI:1154310530
Name:GLASS, THOMAS A (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:GLASS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PIIKOI ST
Mailing Address - Street 2:STE 1603
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-596-8778
Mailing Address - Fax:808-596-8558
Practice Address - Street 1:1833 KALAKAUA AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1528
Practice Address - Country:US
Practice Address - Phone:808-955-7372
Practice Address - Fax:808-951-9282
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY037103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04997201Medicaid
56960OtherNMSA
56960OtherNMSA
HI04997201Medicaid