MEDICARE: MARIA PETKUS PHD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1023960861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA PETKUS PHD, LLC

Provider Business Mailing Address
First Line	:	516 MANANAI PL APT A
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-5338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 MANANAI PL APT A
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-5338
Country	:	US
Telephone Number	:	831-236-2501
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. MARIA PETKUS
Credential	:	PHD
Telephone Number	:	831-236-2501

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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