Provider Demographics
NPI:1720416464
Name:LIZA M. WACKER, PSY.D., INC.
Entity Type:Organization
Organization Name:LIZA M. WACKER, PSY.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:MALIA
Authorized Official - Last Name:WACKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-927-2587
Mailing Address - Street 1:P.O. BOX 25809
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825
Mailing Address - Country:US
Mailing Address - Phone:808-927-2587
Mailing Address - Fax:866-530-6345
Practice Address - Street 1:3599 WAIALAE AVENUE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-927-2587
Practice Address - Fax:866-530-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY788103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty