| Life Master Llc | |
|
2957 Kalakaua Ave Suite 601 Honolulu HI 96815-4650 | |
| (808) 737-6277 | |
| Not Available |
| Full Name | Life Master Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2957 Kalakaua Ave, Honolulu, Hawaii |
| Authorized Official Name and Position | Mitzi Gold (PSYCHOLOGIST) |
| Authorized Official Contact | 8087376277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Master Llc 2957 Kalakaua Avenue Suite 601 Honolulu HI 96815 Ph: (808) 737-6277 | Life Master Llc 2957 Kalakaua Ave Suite 601 Honolulu HI 96815-4650 Ph: (808) 737-6277 |
| NPI Number | 1083970545 |
|---|---|
| Provider Enumeration Date | 04/09/2012 |
| Last Update Date | 04/09/2012 |
| Medicare PECOS PAC ID | 4587829312 |
|---|---|
| Medicare Enrollment ID | O20120629000191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083970545 | NPI | - | NPPES |
| 55077401 | Medicaid | HI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 663 (Hawaii) | Primary |
| 1041C0700X | Social Worker - Clinical | 3105 (Hawaii) | Secondary |
| Provider Name | Mitzi Gold |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093750895 PECOS PAC ID: 5991602930 Enrollment ID: I20031217000495 |
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