| Psychological Service Center, Llc | |
|
1135 Makawao Ave Makawao HI 96768-7403 | |
| (808) 280-9457 | |
| (808) 572-0311 |
| Full Name | Psychological Service Center, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1135 Makawao Ave, Makawao, Hawaii |
| Authorized Official Name and Position | Daniel J Lane (CHIEF PSYCHOLOGIST) |
| Authorized Official Contact | 8082809457 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Service Center, Llc 126 Peni Pl Kula HI 96790-8772 Ph: (808) 280-9457 | Psychological Service Center, Llc 1135 Makawao Ave Makawao HI 96768-7403 Ph: (808) 280-9457 |
| NPI Number | 1194964353 |
|---|---|
| Provider Enumeration Date | 02/11/2009 |
| Last Update Date | 02/11/2009 |
| Medicare PECOS PAC ID | 8527078864 |
|---|---|
| Medicare Enrollment ID | O20060501000520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194964353 | NPI | - | NPPES |
| 00A0258473 | Other | HI | HMSA |
| 57950002 | Medicaid | HI | |
| 548195324 | Other | HI | UNIVERSITY HEALTH ALLIANCE |
| 57950000-1 | Other | HI | ALOHA CARE QUEST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY (Hawaii) | Primary |
| Provider Name | Daniel J Lane |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457445934 PECOS PAC ID: 1951311299 Enrollment ID: I20060502000044 |
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