Provider Demographics
NPI:1154357903
Name:HOSENFELD, CHARLENE A (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:A
Last Name:HOSENFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 ULUNIU ST.,
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1972
Mailing Address - Country:US
Mailing Address - Phone:808-261-4305
Mailing Address - Fax:
Practice Address - Street 1:328 ULUNIU ST.
Practice Address - Street 2:SUITE 207
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1972
Practice Address - Country:US
Practice Address - Phone:808-261-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI045935-01Medicaid
HIR16606Medicare UPIN
51470Medicare ID - Type Unspecified