Healthcare Provider Details

I. General information

NPI: 1871766352
Provider Name (Legal Business Name): SHARON RAE LIDEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 LANAI AVE.
LANAI CITY HI
96763
US

IV. Provider business mailing address

PO BOX 631138 272 LANAI AVENUE
LANAI CITY HI
96763-1138
US

V. Phone/Fax

Practice location:
  • Phone: 808-649-0032
  • Fax:
Mailing address:
  • Phone: 808-649-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-16129
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC32157
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-81
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-1779
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: