| Kelly H Takasawa, Psyd Llc | |
|
1221 Kapiolani Blvd Ste 211 Honolulu HI 96814-3506 | |
| (808) 538-7793 | |
| Not Available |
| Full Name | Kelly H Takasawa, Psyd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1221 Kapiolani Blvd Ste 211, Honolulu, Hawaii |
| Authorized Official Name and Position | Kelly Takasawa (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8085387793 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly H Takasawa, Psyd Llc 1221 Kapiolani Blvd Ste 211 Honolulu HI 96814-3506 Ph: (808) 538-7793 | Kelly H Takasawa, Psyd Llc 1221 Kapiolani Blvd Ste 211 Honolulu HI 96814-3506 Ph: (808) 538-7793 |
| NPI Number | 1871001636 |
|---|---|
| Provider Enumeration Date | 01/15/2018 |
| Last Update Date | 01/15/2018 |
| Medicare PECOS PAC ID | 0749541274 |
|---|---|
| Medicare Enrollment ID | O20180226001871 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871001636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY-1215 (Hawaii) | Primary |
| 103TH0004X | Psychologist - Health | PSY-1215 (Hawaii) | Secondary |
| Provider Name | Kelly H Takasawa Betwee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508166877 PECOS PAC ID: 9133318835 Enrollment ID: I20180226002050 |
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