Provider Demographics
NPI:1588799373
Name:HALL, SUSAN L (PH D)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 3007
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3301
Mailing Address - Country:US
Mailing Address - Phone:808-599-1636
Mailing Address - Fax:808-599-8612
Practice Address - Street 1:4-1558 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1856
Practice Address - Country:US
Practice Address - Phone:808-651-4860
Practice Address - Fax:808-822-7048
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY377103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52102205Medicaid
HI52102205Medicaid
HI55457Medicare ID - Type Unspecified