Provider Demographics
NPI:1457431470
Name:HIGASHINO, DALE T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:T
Last Name:HIGASHINO
Suffix:
Gender:M
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:PO BOX 25311
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0311
Mailing Address - Country:US
Mailing Address - Phone:808-497-7435
Mailing Address - Fax:808-373-7972
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:SUITE 600
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-497-7435
Practice Address - Fax:808-373-7972
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00D0204976OtherHMSA