Provider Demographics
NPI:1275871220
Name:UMAKI, TRACIE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:MARIE
Last Name:UMAKI
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 1:438 HOBRON LN STE 415
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1229
Mailing Address - Country:US
Mailing Address - Phone:808-292-7396
Mailing Address - Fax:808-599-7900
Practice Address - Street 1:438 HOBRON LN
Practice Address - Street 2:SUITE 409
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1233
Practice Address - Country:US
Practice Address - Phone:808-258-6872
Practice Address - Fax:808-599-7900
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4166103TC0700X
HI1378103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical