Healthcare Provider Details

I. General information

NPI: 1255454583
Provider Name (Legal Business Name): LINDA C FOX PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA CHAPANIS

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1841 FORT WEAVER RD
EWA BEACH HI
96706-1909
US

IV. Provider business mailing address

PO BOX 17034
HONOLULU HI
96817-0034
US

V. Phone/Fax

Practice location:
  • Phone: 808-748-3146
  • Fax: 808-591-1017
Mailing address:
  • Phone: 808-292-3078
  • Fax: 808-545-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number153
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number896
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: