Provider Demographics
NPI:1578641775
Name:BRATTON, JOSEPH C (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:BRATTON
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 1:101 AUPUNI ST
Mailing Address - Street 2:216
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4246
Mailing Address - Country:US
Mailing Address - Phone:808-934-0544
Mailing Address - Fax:808-934-7634
Practice Address - Street 1:101 AUPUNI ST
Practice Address - Street 2:216
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4246
Practice Address - Country:US
Practice Address - Phone:808-934-0544
Practice Address - Fax:808-934-7634
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI104103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05281001Medicaid
HIA60408OtherHMSA