Provider Demographics
NPI:1801150560
Name:JOANNE BAUTISTA-TORRES PSYD. LLC
Entity type:Organization
Organization Name:JOANNE BAUTISTA-TORRES PSYD. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-646-1322
Mailing Address - Street 1:7192 KALANIANAOLE HWY
Mailing Address - Street 2:SUITE A143A PMB159
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1800
Mailing Address - Country:US
Mailing Address - Phone:808-646-1322
Mailing Address - Fax:
Practice Address - Street 1:119 MERCHANT ST
Practice Address - Street 2:SUITE 605
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4452
Practice Address - Country:US
Practice Address - Phone:808-646-1322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty