Healthcare Provider Details

I. General information

NPI: 1699052514
Provider Name (Legal Business Name): CAROLINE COCHRAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2011
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-216 FARRINGTON HIGHWAY SUITE 200
WAIALUA HI
96791
US

IV. Provider business mailing address

PO BOX 911241
WAIALUA HI
96791
US

V. Phone/Fax

Practice location:
  • Phone: 808-542-3030
  • Fax:
Mailing address:
  • Phone: 808-542-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number279
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: