Provider Demographics
NPI:1962658252
Name:ZICHITTELLA, WESTON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WESTON
Middle Name:
Last Name:ZICHITTELLA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-084 KAMEHAMEHA HWY STE 301A
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5124
Mailing Address - Country:US
Mailing Address - Phone:808-484-1122
Mailing Address - Fax:808-484-1129
Practice Address - Street 1:147-2 OKO ST.
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-397-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1301103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist