Healthcare Provider Details

I. General information

NPI: 1811129810
Provider Name (Legal Business Name): AMELIA KOTTE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 DOLE ST PSYCHOLOGY DEPARTMENT, SAKAMAKI D-410
HONOLULU HI
96822-2309
US

IV. Provider business mailing address

2530 DOLE ST PSYCHOLOGY DEPARTMENT, SAKAMAKI D-410
HONOLULU HI
96822-2309
US

V. Phone/Fax

Practice location:
  • Phone: 619-723-6915
  • Fax:
Mailing address:
  • Phone: 619-723-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1561
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: