MEDICARE: DR. KENNETH A DELANO PHD

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	1911	CO
2	103TC0700X	Clinical Psychologist	1484	HI

General Provider Information

NPI Number	:	1215900576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A DELANO PHD

Provider Business Mailing Address
First Line	:	92-1061 KOIO DR APT D
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96707-2268
Country	:	US
Telephone Number	:	719-233-3973
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-2301 OLD FT WEAVER RD
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3602
Country	:	US
Telephone Number	:	808-677-2823
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	10/18/2016

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