Provider Demographics
NPI:1831265586
Name:GERARD, DIANNE M (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:M
Last Name:GERARD
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 1:4371 PUAOLE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1231
Mailing Address - Country:US
Mailing Address - Phone:808-246-4501
Mailing Address - Fax:808-245-7504
Practice Address - Street 1:4371 PUAOLE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1231
Practice Address - Country:US
Practice Address - Phone:808-246-4501
Practice Address - Fax:808-245-7504
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04472501Medicaid
0000TCBMCMedicare ID - Type Unspecified
HI04472501Medicaid