Provider Demographics
NPI:1972879872
Name:MORAVEC, NICOLE (PSYD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MORAVEC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 BISHOP ST STE 1510
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2817
Mailing Address - Country:US
Mailing Address - Phone:808-492-8780
Mailing Address - Fax:
Practice Address - Street 1:1314 S KING ST
Practice Address - Street 2:SUITE 862
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1956
Practice Address - Country:US
Practice Address - Phone:808-223-2687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1314103T00000X
HIPSY 1314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist