Provider Demographics
NPI:1841591112
Name:EAVES-HERRERA, MARYRUTH (PHD)
Entity Type:Individual
Prefix:
First Name:MARYRUTH
Middle Name:
Last Name:EAVES-HERRERA
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 1:101 AUPUNI ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4246
Mailing Address - Country:US
Mailing Address - Phone:808-238-0543
Mailing Address - Fax:
Practice Address - Street 1:101 AUPUNI ST
Practice Address - Street 2:STE 313
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4262
Practice Address - Country:US
Practice Address - Phone:719-659-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist