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General NPI Number Information
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NPI Number | 1083970545
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Entity Type | Organization
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Legal Business Name | LIFE MASTER LLC
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 2957 KALAKAUA AVE SUITE 601
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City | HONOLULU
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State | HI
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Zip | 96815-4650
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Country | US
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Telephone | 808-737-6277
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Fax |
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Provider Business Mailing Address
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Address Line | 2957 KALAKAUA AVENUE SUITE 601
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City | HONOLULU
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State | HI
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Zip | 96815
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Country | US
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Telephone | 808-737-6277
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MITZI GOLD
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Credential | PH.D, CLSW, MPH
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Telephone | 808-737-6277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3105
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 663
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License Number State | HI
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