Healthcare Provider Details

I. General information

NPI: 1487086609
Provider Name (Legal Business Name): AMANDA POPOVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA ROHRABAUGH

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 IAUKEA ST
HONOLULU HI
96813-1428
US

IV. Provider business mailing address

545 IAUKEA ST
HONOLULU HI
96813-1428
US

V. Phone/Fax

Practice location:
  • Phone: 808-208-3458
  • Fax:
Mailing address:
  • Phone: 808-208-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: