Provider Demographics
NPI:1326016205
Name:BROWN, ROBERT J (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BROWN
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:PO BOX 1783
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-5783
Mailing Address - Country:US
Mailing Address - Phone:808-822-5881
Mailing Address - Fax:808-823-6535
Practice Address - Street 1:4566 OHIA ST
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1646
Practice Address - Country:US
Practice Address - Phone:808-822-5881
Practice Address - Fax:808-823-6535
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-433103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI06530601Medicaid
HIR18385Medicare UPIN
HI101290Medicare PIN