Healthcare Provider Details

I. General information

NPI: 1962658252
Provider Name (Legal Business Name): WESTON ZICHITTELLA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147-2 OKO ST.
KAILUA HI
96734
US

IV. Provider business mailing address

98-084 KAMEHAMEHA HWY STE 301A
AIEA HI
96701-5124
US

V. Phone/Fax

Practice location:
  • Phone: 808-397-6122
  • Fax:
Mailing address:
  • Phone: 808-484-1122
  • Fax: 808-484-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1301
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: