1790772093 NPI number — DR. KATHLEEN MARIANNE MCNAMARA PH.D.

Table of content: DR. KATHLEEN MARIANNE MCNAMARA PH.D. (NPI 1790772093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790772093 NPI number — DR. KATHLEEN MARIANNE MCNAMARA PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNAMARA
Provider First Name:
KATHLEEN
Provider Middle Name:
MARIANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1790772093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 330489
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAHULUI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96733-0489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-876-0098
Provider Business Mailing Address Fax Number:
808-878-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1129 LOWER MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-876-0098
Provider Business Practice Location Address Fax Number:
808-878-8908
Provider Enumeration Date:
10/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PSY 408 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY408 , 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: 061555 01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08180 . This is a "HMSA PROVIDER ROOT NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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