Healthcare Provider Details

I. General information

NPI: 1912295312
Provider Name (Legal Business Name): ROBYN TAKESHITA DEBARY PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S BERETANIA ST SUITE 218
HONOLULU HI
96814-1520
US

IV. Provider business mailing address

PO BOX 970809
WAIPAHU HI
96797-0809
US

V. Phone/Fax

Practice location:
  • Phone: 808-783-3387
  • Fax: 866-592-3149
Mailing address:
  • Phone: 808-664-1104
  • Fax: 866-592-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 1264
License Number StateHI

VIII. Authorized Official

Name: ROBYN TAKESHITA DEBARY
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 808-664-1104