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NPI Code Detail

MEDICARE: YURIE I VAN DERMARK PSYD

MEDICARE: YURIE I VAN DERMARK PSYD
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
1101YM0800XMental Health Counselor
2103TC0700XClinical PsychologistPSY-2060-0HI
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1720503576
Entity Type Code : Individual
Provider Name (Legal Business Name) : YURIE I VAN DERMARK PSYD
Provider Business Mailing Address
First Line : 1050 QUEEN ST STE 100
Second Line :
City : HONOLULU
State : HI
Zip : 96814-4130
Country : US
Telephone Number : 808-692-3628
Fax Number :
Provider Business Practice Location Address
First Line : 1050 QUEEN ST STE 100
Second Line :
City : HONOLULU
State : HI
Zip : 96814-4130
Country : US
Telephone Number : 808-692-3628
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2017
Last Update Date : 03/18/2026

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Directions to “ YURIE I VAN DERMARK PSYD” Practice Location

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