Healthcare Provider Details

I. General information

NPI: 1891764460
Provider Name (Legal Business Name): JAY VAN FLEET PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI STREET SUITE 1409
HONOLULU HI
96814
US

IV. Provider business mailing address

615 PIIKOI STREET SUITE 1409
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-285-4776
  • Fax:
Mailing address:
  • Phone: 808-285-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1399
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: