MEDICARE: DR. BRENDA JOYCE ANDRIEU PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 717	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114970605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA JOYCE ANDRIEU PH.D.

Provider Business Mailing Address
First Line	:	91-1653 AUWAHA ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1815
Country	:	US
Telephone Number	:	808-681-0091
Fax Number	:	808-681-0091

Provider Business Practice Location Address
First Line	:	91-1653 AUWAHA ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1815
Country	:	US
Telephone Number	:	808-681-0091
Fax Number	:	808-681-0091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/09/2007

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