Provider Demographics
NPI:1972810893
Name:BROUWERS, GERALD MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MARK
Last Name:BROUWERS
Suffix:
Gender:M
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:PO BOX 61127
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96839-1127
Mailing Address - Country:US
Mailing Address - Phone:808-220-6689
Mailing Address - Fax:808-732-3824
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:KAHALA OFFICE TOWER, SUITE 307
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5319
Practice Address - Country:US
Practice Address - Phone:808-737-3800
Practice Address - Fax:808-737-9918
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI445103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent