Healthcare Provider Details

I. General information

NPI: 1639852825
Provider Name (Legal Business Name): BEWELL MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1191 LEOLANI ST
MILILANI HI
96789-3608
US

IV. Provider business mailing address

95-1191 LEOLANI ST
MILILANI HI
96789-3608
US

V. Phone/Fax

Practice location:
  • Phone: 808-265-5791
  • Fax: 808-791-4123
Mailing address:
  • Phone: 808-265-5791
  • Fax: 808-791-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DANIELA GRANZOTTO
Title or Position: OWNER
Credential: PSYD
Phone: 808-265-5791