1699196345 NPI number — PAUL RICHARD PAUMALU CASSIDAY III B.A. PSYCHOLOGY

Table of content: PAUL RICHARD PAUMALU CASSIDAY III B.A. PSYCHOLOGY (NPI 1699196345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699196345 NPI number — PAUL RICHARD PAUMALU CASSIDAY III B.A. PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASSIDAY
Provider First Name:
PAUL RICHARD
Provider Middle Name:
PAUMALU
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
B.A. PSYCHOLOGY
Provider Gender Code:
M

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:
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Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699196345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 PIIKOI ST STE 203
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:
96814-3139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 KAHELU AVE STE 221
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILILANI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96789-3962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-206-9371
Provider Business Practice Location Address Fax Number:
855-270-7441
Provider Enumeration Date:
12/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
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Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW-5140 , 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)





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