Provider Demographics
NPI:1265928873
Name:HUMPHREY, AMY (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:HUMPHREY
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 1:3029 LOWREY AVE APT H3116
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-6821
Mailing Address - Country:US
Mailing Address - Phone:614-214-6349
Mailing Address - Fax:
Practice Address - Street 1:615 PIIKOI ST STE 1605
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3142
Practice Address - Country:US
Practice Address - Phone:808-352-5050
Practice Address - Fax:808-564-0029
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty