Provider Demographics
NPI:1891748992
Name:JOHNSON, LESLIE MARTIN JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MARTIN
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:L
Other - Middle Name:MARTIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1001 BISHOP STREET
Mailing Address - Street 2:SUITE 2870
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3482
Mailing Address - Country:US
Mailing Address - Phone:808-538-7793
Mailing Address - Fax:808-538-7799
Practice Address - Street 1:1001 BISHOP STREET
Practice Address - Street 2:SUITE 2870
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3482
Practice Address - Country:US
Practice Address - Phone:808-538-7793
Practice Address - Fax:808-538-7799
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 736103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000230755OtherHMSA QUEST
HI99-0351398OtherHMA
HI611304000OtherUS DEPT. OF LABOR
HI99-0351395OtherHMAA
HI0000230755OtherHMSA 65C PLUS
HI99-0351398OtherKAISER ADDED CHOICE
HI99-0351398OtherUNITED HEALTH CARE
HI50206402Medicaid
HI99-0351398OtherWPS-TRICARE
HI230755OtherBLUE CROSS/BLUE SHIELD
HI230755OtherHMSA
HI50206401OtherALOHACARE (QUEST)
HI99-0351398OtherFEI BEHAVIORAL HEALTH
HI99-0351398OtherHMA-SUMMERLINE
HI99-0351398OtherMDX (QUEEN'S) HAWAII
HI0000230755OtherHMSA CCS
HI230755OtherBC/BS; UNITED GOV. SVC
HI99-0351398OtherAIG-NO FAULT INS.
HI230755OtherBC/BS; UNITED GOV. SVC