Healthcare Provider Details

I. General information

NPI: 1588811814
Provider Name (Legal Business Name): CAROL JANE GOLDBLATT PSY.D., J.D., CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S KING ST SUITE 408
HONOLULU HI
96813-3020
US

IV. Provider business mailing address

715 S KING ST SUITE 408
HONOLULU HI
96813-3020
US

V. Phone/Fax

Practice location:
  • Phone: 808-723-7745
  • Fax: 808-723-7748
Mailing address:
  • Phone: 808-723-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1044
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1044
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1044
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1044
License Number StateHI
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1044
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1044
License Number StateHI
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1044
License Number StateHI
# 8
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number1044
License Number StateHI
# 9
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1044
License Number StateHI
# 10
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1044
License Number StateHI
# 11
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1044
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: