1497951271 NPI number — TERENCE C WADE PHD INC

Table of content: (NPI 1497951271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497951271 NPI number — TERENCE C WADE PHD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERENCE C WADE PHD 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:
Provider Other Organization Name Type Code:
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:
1497951271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1188 BISHOP ST STE 3205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-545-7706
Provider Business Mailing Address Fax Number:
413-812-4219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1188 BISHOP ST STE 3205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-545-7706
Provider Business Practice Location Address Fax Number:
413-812-4219
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WADE
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
808-545-7706

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY161 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW3168 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 2911 . This is a "ALOHACARE ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 9911634 . This is a "UHA ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: B002 . This is a "TRICARE ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: LSCW3168 . This is a "MDX HAWAII ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: PSY161 . This is a "HMAA ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000005926 . This is a "HMSA ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 2912 . This is a "ALOHACARE ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 208654 . This is a "SUMMERLIN, HMA, HMN ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 2170634 . This is a "UHA ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: B003 . This is a "TRICARE ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 05365701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: PSY161 . This is a "MDX HAWAII ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000061655 . This is a "HMSA ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: LCSW3168 . This is a "HMAA ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 510372 . This is a "SUMMERLIN, HMA, HMN ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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