Healthcare Provider Details

I. General information

NPI: 1053621508
Provider Name (Legal Business Name): EDITH VAJDA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EDIE VAJDA PSYD

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST STE 1605
HONOLULU HI
96814-3142
US

IV. Provider business mailing address

615 PIIKOI ST STE 1605
HONOLULU HI
96814-3142
US

V. Phone/Fax

Practice location:
  • Phone: 808-352-5050
  • Fax: 808-564-0029
Mailing address:
  • Phone: 808-352-5050
  • Fax: 808-564-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: