Provider Demographics
NPI:1538293188
Name:KOSEL, SANDRA JOY (PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOY
Last Name:KOSEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S KIHEI RD
Mailing Address - Street 2:STE 0-208
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5220
Mailing Address - Country:US
Mailing Address - Phone:808-875-1348
Mailing Address - Fax:808-442-0042
Practice Address - Street 1:2752 OHINA ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8548
Practice Address - Country:US
Practice Address - Phone:808-875-1348
Practice Address - Fax:808-442-0042
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHMSA00C0080832OtherHMSA PROVIDER ID
HIOOOOTCBPSMedicare ID - Type Unspecified