Provider Demographics
NPI:1518283365
Name:MARK DICHNER, PHD., INCORPORATED
Entity Type:Organization
Organization Name:MARK DICHNER, PHD., INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DICHNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-689-8811
Mailing Address - Street 1:91-1009 KAIMOANA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6071
Mailing Address - Country:US
Mailing Address - Phone:808-689-8811
Mailing Address - Fax:808-689-0316
Practice Address - Street 1:92-1238 KAAHUMANU ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3250
Practice Address - Country:US
Practice Address - Phone:808-689-8811
Practice Address - Fax:808-689-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PSY-315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0932101500031-001Medicare UPIN