Healthcare Provider Details

I. General information

NPI: 1023153889
Provider Name (Legal Business Name): REBECCA MARIE BEARDSLEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 KALAKAUA AVE STE 908
HONOLULU HI
96815-1528
US

IV. Provider business mailing address

C/O ABS PO BOX 60599
EWA BEACH HI
96706-7599
US

V. Phone/Fax

Practice location:
  • Phone: 808-664-1104
  • Fax: 866-592-3149
Mailing address:
  • Phone: 808-664-1104
  • Fax: 866-592-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: