=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508511205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAUREEN MENCH, PSYD.,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2022
-----------------------------------------------------
Last Update Date | 02/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 337 ULUNIU ST STE 201
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-394-7830
-----------------------------------------------------
Fax | 808-720-6623
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1464 ULUHALA PL
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-4413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-394-7830
-----------------------------------------------------
Fax | 808-620-7723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MAUREEN EDAH MENCH
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 808-394-7830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------