Provider Demographics
NPI:1790877348
Name:NOVA, CATHRYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHRYN
Middle Name:
Last Name:NOVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:NOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:75-240 NANI KAILUA DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2074
Mailing Address - Country:US
Mailing Address - Phone:808-329-2700
Mailing Address - Fax:808-327-0343
Practice Address - Street 1:75-240 NANI KAILUA DR
Practice Address - Street 2:SUITE 10
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2074
Practice Address - Country:US
Practice Address - Phone:808-329-2700
Practice Address - Fax:808-327-0343
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07511802Medicaid
HIH52091Medicare PIN