1598092959 NPI number — SHERRIE M. TAKUSHI, PSY.D., INC.

Table of content: (NPI 1598092959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598092959 NPI number — SHERRIE M. TAKUSHI, PSY.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERRIE M. TAKUSHI, PSY.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHERRIE M. TAKUSHI, PSY.D.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598092959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96701-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-484-2181
Provider Business Mailing Address Fax Number:
808-484-2189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98-211 PALI MOMI ST STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-484-2181
Provider Business Practice Location Address Fax Number:
808-484-2189
Provider Enumeration Date:
11/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAKUSHI-ISARA
Authorized Official First Name:
SHERRIE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-551-8579

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY-712 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00T0228555 . This is a "HAWAII MEDICAL SERVICE ASSOCIATION (BLUE CROSS/BLUE SHIELD)" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 5161802 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".