Provider Demographics
NPI:1891742474
Name:STAMPER, EWA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:EWA
Middle Name:S
Last Name:STAMPER
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 1:41-019 HIHIMANU ST
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1607
Mailing Address - Country:US
Mailing Address - Phone:808-259-7672
Mailing Address - Fax:
Practice Address - Street 1:30 AULIKE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2739
Practice Address - Country:US
Practice Address - Phone:808-261-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY525103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI028016Medicaid
HI00A0031326OtherHMSA PIN #
HI52713Medicare PIN