Provider Demographics
NPI:1568195337
Name:DENNIS PAUL ITOGA, PSY.D., M.ED., LLC
Entity Type:Organization
Organization Name:DENNIS PAUL ITOGA, PSY.D., M.ED., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ITOGA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-352-7911
Mailing Address - Street 1:2126 MOTT-SMITH DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2516
Mailing Address - Country:US
Mailing Address - Phone:808-352-7911
Mailing Address - Fax:
Practice Address - Street 1:2126 MOTT-SMITH DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2516
Practice Address - Country:US
Practice Address - Phone:808-352-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1619453180OtherHMSA