1669542759 NPI number — DR. DAWN ELIZABETH MONTGOMERY PSY.D.

Table of content: DR. DAWN ELIZABETH MONTGOMERY PSY.D. (NPI 1669542759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669542759 NPI number — DR. DAWN ELIZABETH MONTGOMERY PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
DAWN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELTON
Provider Other First Name:
DAWN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669542759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
745 ISENBERG STREET
Provider Second Line Business Mailing Address:
SUITE 902
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-492-0296
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 BISHOP ST STE 512
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:
96813-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-492-0296
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

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: 103TC0700X , with the licence number:  PSY1467 , 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: PSY 1467 . This is a "PSYCHOLOGIST/CLINICAL" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".