MEDICARE: DENNIS PAUL ITOGA, PSY.D., M.ED., LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619453180	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1568195337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS PAUL ITOGA, PSY.D., M.ED., LLC

Provider Business Mailing Address
First Line	:	2126 MOTT-SMITH DR
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-2516
Country	:	US
Telephone Number	:	808-352-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 MOTT-SMITH DR
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-2516
Country	:	US
Telephone Number	:	808-352-7911
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SUPERVISOR
Name	:	DR. DENNIS P ITOGA
Credential	:	PSY.D.
Telephone Number	:	808-352-7911

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	07/07/2022

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