Healthcare Provider Details

I. General information

NPI: 1154310530
Provider Name (Legal Business Name): THOMAS A GLASS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 KALAKAUA AVE SUITE 800
HONOLULU HI
96815-1528
US

IV. Provider business mailing address

615 PIIKOI ST STE 1603
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-7372
  • Fax: 808-951-9282
Mailing address:
  • Phone: 808-596-8778
  • Fax: 808-596-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY037
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: