Healthcare Provider Details

I. General information

NPI: 1093840894
Provider Name (Legal Business Name): DR SUSAN HALL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 OHIA ST
KAPAA HI
96746-1646
US

IV. Provider business mailing address

PO BOX 26049
HONOLULU HI
96825-6049
US

V. Phone/Fax

Practice location:
  • Phone: 808-651-4860
  • Fax: 808-822-7048
Mailing address:
  • Phone: 808-394-6206
  • Fax: 808-394-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY377
License Number StateHI

VIII. Authorized Official

Name: SUSAN L HALL
Title or Position: PRESIDENT
Credential: PH. D.
Phone: 808-394-6206