Provider Demographics
NPI:1801973391
Name:WHITE, JUDITH C (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1719
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-5719
Mailing Address - Country:US
Mailing Address - Phone:808-346-5859
Mailing Address - Fax:
Practice Address - Street 1:4-885 KUHIO HWY # A-1
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2702
Practice Address - Country:US
Practice Address - Phone:808-346-5859
Practice Address - Fax:808-822-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI23906-1OtherHMSA PROVIDER NUMBER