Provider Demographics
NPI:1275794315
Name:CHILD DEVELOPMENT CENTER OF HAWAII, LLC
Entity Type:Organization
Organization Name:CHILD DEVELOPMENT CENTER OF HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:BEVERIDGE
Authorized Official - Last Name:DENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-737-4300
Mailing Address - Street 1:4211 WAIALAE AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5306
Mailing Address - Country:US
Mailing Address - Phone:808-737-4300
Mailing Address - Fax:808-737-4302
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5306
Practice Address - Country:US
Practice Address - Phone:808-737-4300
Practice Address - Fax:808-737-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 697103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty