Provider Demographics
NPI:1346272432
Name:GOODYEAR, BRIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:GOODYEAR
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 1:2924 ALPHONSE PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1704
Mailing Address - Country:US
Mailing Address - Phone:808-285-9393
Mailing Address - Fax:
Practice Address - Street 1:354-A ULUNIU STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-0000
Practice Address - Country:US
Practice Address - Phone:808-285-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical