Provider Demographics
NPI:1013101880
Name:MCANESBY, JUDEA LEIGH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUDEA
Middle Name:LEIGH
Last Name:MCANESBY
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 1:65-1242 PAKO PL
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8364
Mailing Address - Country:US
Mailing Address - Phone:510-220-4737
Mailing Address - Fax:
Practice Address - Street 1:65-1242 PAKO PL
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8364
Practice Address - Country:US
Practice Address - Phone:808-238-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1461103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPSY-1461OtherSTATE LICENSE