Provider Demographics
NPI:1740857101
Name:PSYCHIATRIC ASSOCIATES
Entity type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-728-0484
Mailing Address - Street 1:98-1247 KAAHUMANU ST STE 116
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5300
Mailing Address - Country:US
Mailing Address - Phone:808-762-0911
Mailing Address - Fax:808-626-5161
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 116
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5300
Practice Address - Country:US
Practice Address - Phone:808-762-0911
Practice Address - Fax:808-626-5161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHIATRIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-04
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI001356Medicaid