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General NPI Number Information
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NPI Number | 1093108029
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Entity Type | Organization
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Legal Business Name | MARY C. NEEDHAM, PH.D., LLC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 1221 KAPIOLANI BLVD PH 38
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City | HONOLULU
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State | HI
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Zip | 96814-3518
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Country | US
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Telephone | 323-686-2584
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Fax | 866-925-4284
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Provider Business Mailing Address
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Address Line | 1221 KAPIOLANI BLVD PH 38
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City | HONOLULU
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State | HI
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Zip | 96814-3518
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Country | US
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Telephone | 323-686-2584
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Fax | 866-925-4284
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MARY C. NEEDHAM
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Credential | PH.D.
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Telephone | 323-686-2584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY-1508
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License Number State | HI
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