Provider Demographics
NPI:1790772093
Name:MCNAMARA, KATHLEEN MARIANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIANNE
Last Name:MCNAMARA
Suffix:
Gender:F
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:PO BOX 330489
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96733-0489
Mailing Address - Country:US
Mailing Address - Phone:808-876-0098
Mailing Address - Fax:808-878-8908
Practice Address - Street 1:1129 LOWER MAIN ST
Practice Address - Street 2:SUITE 305
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2053
Practice Address - Country:US
Practice Address - Phone:808-876-0098
Practice Address - Fax:808-878-8908
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-02
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 408103G00000X
HIPSY408103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI061555 01Medicaid
HI08180OtherHMSA PROVIDER ROOT NUMBER
HI08180OtherHMSA PROVIDER ROOT NUMBER
HIH0000TCBNWMedicare PIN