Provider Demographics
NPI:1770697419
Name:SHIMIZU, ANNETTE A (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:A
Last Name:SHIMIZU
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 1:1100 WARD AVE
Mailing Address - Street 2:SUITE 840
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1600
Mailing Address - Country:US
Mailing Address - Phone:808-522-4521
Mailing Address - Fax:808-522-3320
Practice Address - Street 1:1100 WARD AVE
Practice Address - Street 2:SUITE 840
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1600
Practice Address - Country:US
Practice Address - Phone:808-522-4521
Practice Address - Fax:808-522-3320
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical