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General NPI Number Information
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NPI Number | 1306271093
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Entity Type | Individual
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Provider Name | GRACIETE LO PHD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 2855 E MANOA RD STE 105 #159
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City | HONOLULU
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State | HI
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Zip | 96822
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Country | US
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Telephone | 646-801-8219
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Fax |
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Provider Business Mailing Address
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Address Line | 3215 ALA ILIMA ST APT B501
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City | HONOLULU
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State | HI
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Zip | 96818-2908
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Country | US
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Telephone | 646-284-4551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 020268
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License Number State | NY
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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 | PSY-1433
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License Number State | HI
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