Provider Demographics
NPI:1932241882
Name:STERN, JEFFREY D (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:STERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 KALAKAUA AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1527
Mailing Address - Country:US
Mailing Address - Phone:808-387-3703
Mailing Address - Fax:
Practice Address - Street 1:1833 KALAKAUA AVE STE 503
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1527
Practice Address - Country:US
Practice Address - Phone:808-387-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI248039OtherHMSA, PROVIDER NUMBER