Provider Demographics
NPI:1649769019
Name:HAWAII CLINICAL PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:HAWAII CLINICAL PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:J'ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-778-5755
Mailing Address - Street 1:1188 BISHOP ST STE 3005
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3312
Mailing Address - Country:US
Mailing Address - Phone:808-778-5755
Mailing Address - Fax:866-278-2435
Practice Address - Street 1:1188 BISHOP ST STE 3005
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3312
Practice Address - Country:US
Practice Address - Phone:808-778-5755
Practice Address - Fax:866-278-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1503261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIN1338916Medicaid