Provider Demographics
NPI:1417107939
Name:ORR, ERIC GLENN SR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GLENN
Last Name:ORR
Suffix:SR
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 1:55-060 NAUPAKA ST
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-1127
Mailing Address - Country:US
Mailing Address - Phone:808-293-8696
Mailing Address - Fax:808-675-3525
Practice Address - Street 1:55-510 KAMEHAMEHA HWY STE 14
Practice Address - Street 2:
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762-1197
Practice Address - Country:US
Practice Address - Phone:808-780-6925
Practice Address - Fax:808-489-0926
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1048103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist