Healthcare Provider Details

I. General information

NPI: 1730170481
Provider Name (Legal Business Name): DR. RAYMOND ALEXANDER FOLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE ROAD DEPARTMENT OF PSYCHOLOGY MCHK-PH
HONOLULU HI
96822
US

IV. Provider business mailing address

3577 PINAO ST 16
HONOLULU HI
96822-1183
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-5865
  • Fax:
Mailing address:
  • Phone: 808-988-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY-178
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: