Provider Demographics
NPI:1952391013
Name:RALEIGH, DIANE L (PHD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:RALEIGH
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 1:224 LUMAHAI PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2120
Mailing Address - Country:US
Mailing Address - Phone:808-396-9758
Mailing Address - Fax:808-396-9781
Practice Address - Street 1:224 LUMAHAI PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-2120
Practice Address - Country:US
Practice Address - Phone:808-396-9758
Practice Address - Fax:808-396-9781
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY450103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
91967OtherHMSA
R75205Medicare UPIN
91967OtherHMSA