Provider Demographics
NPI:1437379237
Name:DONOVAN, DENNIS R (PHD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:DONOVAN
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 1:2439 KAPIOLANI BLVD
Mailing Address - Street 2:APT 1702
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826
Mailing Address - Country:US
Mailing Address - Phone:808-941-4160
Mailing Address - Fax:
Practice Address - Street 1:1164 BISHOP ST
Practice Address - Street 2:#1502
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-381-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI389103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05611OtherHMSA