1992208086 NPI number — AMY WASSMAN PSYD LLC

Table of content: JAZMIN CARISSE BARTILET REFUERZO PT (NPI 1114467263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992208086 NPI number — AMY WASSMAN PSYD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMY WASSMAN PSYD LLC
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:
1992208086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 BISHOP ST STE 2870
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:
96813-3482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-726-0750
Provider Business Mailing Address Fax Number:
707-948-6036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BISHOP ST STE 2870
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:
96813-3482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-726-0750
Provider Business Practice Location Address Fax Number:
707-948-6036
Provider Enumeration Date:
03/14/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WASSMAN
Authorized Official First Name:
AMY
Authorized Official Middle Name:
KG
Authorized Official Title or Position:
OWNER/CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
808-726-0750

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY-1240 , 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)