Healthcare Provider Details

I. General information

NPI: 1952391013
Provider Name (Legal Business Name): DIANE L RALEIGH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 LUMAHAI PL
HONOLULU HI
96825-2120
US

IV. Provider business mailing address

224 LUMAHAI PL
HONOLULU HI
96825-2120
US

V. Phone/Fax

Practice location:
  • Phone: 808-396-9758
  • Fax: 808-396-9781
Mailing address:
  • Phone: 808-396-9758
  • Fax: 808-396-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY450
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: