Healthcare Provider Details

I. General information

NPI: 1457493462
Provider Name (Legal Business Name): COLIN BEVERIDGE DENNEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 621
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 621
HONOLULU HI
96814-4402
US

V. Phone/Fax

Practice location:
  • Phone: 808-294-3595
  • Fax: 866-270-8635
Mailing address:
  • Phone: 808-294-3595
  • Fax: 866-270-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-697
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 697
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: