Healthcare Provider Details

I. General information

NPI: 1861473670
Provider Name (Legal Business Name): KATHLEEN S BROWN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD MCHK-PH
TAMC HI
96859-5001
US

IV. Provider business mailing address

98-707 IHO PL #805
AIEA HI
96701-2524
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-1323
  • Fax:
Mailing address:
  • Phone: 808-433-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY488
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: