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General NPI Number Information
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NPI Number | 1346272432
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Entity Type | Individual
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Provider Name | BRIAN GOODYEAR PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 354-A ULUNIU STREET SUITE 203
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City | KAILUA
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State | HI
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Zip | 96734-0000
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Country | US
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Telephone | 808-285-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 2924 ALPHONSE PL
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City | HONOLULU
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State | HI
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Zip | 96816-1704
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Country | US
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Telephone | 808-285-9393
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY439
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License Number State | HI
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