Healthcare Provider Details

I. General information

NPI: 1760304992
Provider Name (Legal Business Name): DR SAMANTHA TAVARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3137 HUELANI PL
HONOLULU HI
96822-1238
US

IV. Provider business mailing address

PO BOX 11215
HONOLULU HI
96828-0215
US

V. Phone/Fax

Practice location:
  • Phone: 808-342-3377
  • Fax:
Mailing address:
  • Phone: 808-342-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMANTHA TAVARES
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: P.SYD.
Phone: 808-342-3377