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 1:45-549 PLUMERIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6902
Mailing Address - Country:US
Mailing Address - Phone:808-775-7204
Mailing Address - Fax:808-775-9404
Practice Address - Street 1:45-549 PLUMERIA ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6902
Practice Address - Country:US
Practice Address - Phone:808-775-7204
Practice Address - Fax:808-775-9404
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2017-10-30
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