=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205496890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XENIA EWING PSYD, MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2019
-----------------------------------------------------
Last Update Date | 11/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 KAPIOLANI BLVD PH 50
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-260-9893
-----------------------------------------------------
Fax | 808-748-0433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95-877 WIKAO ST APT D204
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-5038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-391-5087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY-1992
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------