Provider Demographics
NPI:1891994521
Name:GRANZOTTO, DANIELA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
Last Name:GRANZOTTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:95-1191 LEOLANI ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3608
Mailing Address - Country:US
Mailing Address - Phone:808-265-5791
Mailing Address - Fax:808-791-4123
Practice Address - Street 1:94-479 UKEE ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4212
Practice Address - Country:US
Practice Address - Phone:808-265-5791
Practice Address - Fax:808-791-4123
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical