Provider Demographics
NPI:1881667939
Name:MYERS, MARY K (PHD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:MYERS
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 1:1188 BISHOP ST STE 3512
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3314
Mailing Address - Country:US
Mailing Address - Phone:808-550-0991
Mailing Address - Fax:808-550-0992
Practice Address - Street 1:1188 BISHOP ST STE 3512
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3314
Practice Address - Country:US
Practice Address - Phone:808-550-0991
Practice Address - Fax:808-550-0992
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY580103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB206694OtherHMSA
HI07813202Medicaid
S26464Medicare UPIN
HI52236Medicare ID - Type Unspecified