Provider Demographics
NPI:1396017497
Name:HONOLULU PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:HONOLULU PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-386-6851
Mailing Address - Street 1:2228 LILIHA ST STE 404
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1654
Mailing Address - Country:US
Mailing Address - Phone:808-386-6851
Mailing Address - Fax:
Practice Address - Street 1:2228 LILIHA ST STE 404
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1654
Practice Address - Country:US
Practice Address - Phone:808-388-4969
Practice Address - Fax:808-748-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-15998261QM0850X
HIMD159987261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health