Provider Demographics
NPI:1851544704
Name:HARNICK, KELLY C (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:C
Last Name:HARNICK
Suffix:
Gender:F
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WAINEE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1589
Mailing Address - Country:US
Mailing Address - Phone:808-280-4192
Mailing Address - Fax:
Practice Address - Street 1:727 WAINEE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1589
Practice Address - Country:US
Practice Address - Phone:808-280-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1072103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPSY1072OtherHI LICENSE