Provider Demographics
NPI:1669542759
Name:MONTGOMERY, DAWN ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ELIZABETH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:ELIZABETH
Other - Last Name:HELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:745 ISENBERG STREET
Mailing Address - Street 2:SUITE 902
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826
Mailing Address - Country:US
Mailing Address - Phone:808-492-0296
Mailing Address - Fax:
Practice Address - Street 1:1111 BISHOP ST STE 512
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2811
Practice Address - Country:US
Practice Address - Phone:808-492-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1467103TC0700X
171M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPSY 1467OtherPSYCHOLOGIST/CLINICAL