Healthcare Provider Details

I. General information

NPI: 1366403214
Provider Name (Legal Business Name): MELANIE GOTTLIEB PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-298 UALALEHU ST APT 7
MILILANI HI
96789-4119
US

IV. Provider business mailing address

95-298 UALALEHU ST APT 7
MILILANI HI
96789-4119
US

V. Phone/Fax

Practice location:
  • Phone: 808-306-5370
  • Fax: 808-622-4503
Mailing address:
  • Phone: 808-306-5370
  • Fax: 808-622-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number547
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number547
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: