Healthcare Provider Details

I. General information

NPI: 1649769019
Provider Name (Legal Business Name): HAWAII CLINICAL PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 BISHOP ST STE 3005
HONOLULU HI
96813-3312
US

IV. Provider business mailing address

1188 BISHOP ST STE 3005
HONOLULU HI
96813-3312
US

V. Phone/Fax

Practice location:
  • Phone: 808-778-5755
  • Fax: 866-278-2435
Mailing address:
  • Phone: 808-778-5755
  • Fax: 866-278-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY-1503
License Number StateHI

VIII. Authorized Official

Name: DR. CYNTHIA S J'ANTHONY
Title or Position: PRESIDENT
Credential: PHD
Phone: 808-778-5755