Healthcare Provider Details

I. General information

NPI: 1275794315
Provider Name (Legal Business Name): CHILD DEVELOPMENT CENTER OF HAWAII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 WAIALAE AVE SUITE 507
HONOLULU HI
96816-5306
US

IV. Provider business mailing address

4211 WAIALAE AVE SUITE 507
HONOLULU HI
96816-5306
US

V. Phone/Fax

Practice location:
  • Phone: 808-737-4300
  • Fax: 808-737-4302
Mailing address:
  • Phone: 808-737-4300
  • Fax: 808-737-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. COLIN BEVERIDGE DENNEY
Title or Position: DIRECTOR AND MANAGING MEMBER
Credential: PH.D.
Phone: 808-737-4300