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General NPI Number Information
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NPI Number | 1205016730
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Entity Type | Organization
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Legal Business Name | SHANAHAN FAMILY & IND PSYCH SERVICES INC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 2347 OAHU AVE
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City | HONOLULU
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State | HI
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Zip | 96822-1966
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Country | US
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Telephone | 808-941-9307
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Fax |
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Provider Business Mailing Address
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Address Line | 2347 OAHU AVE
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City | HONOLULU
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State | HI
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Zip | 96822-1966
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Country | US
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Telephone | 808-941-9307
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. ROSWITHA SHANAHAN
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Credential |
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Telephone | 808-941-9307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY707
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License Number State | HI
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