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

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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".