Provider Demographics
NPI:1154378768
Name:ALAIMALO, MAVIS M (PSYD, CSAC)
Entity type:Individual
Prefix:DR
First Name:MAVIS
Middle Name:M
Last Name:ALAIMALO
Suffix:
Gender:F
Credentials:PSYD, CSAC
Other - Prefix:
Other - First Name:MAVIS
Other - Middle Name:V
Other - Last Name:MAIAVA-ALAIMALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:98-084 KAMEHAMEHA HWY STE 301B
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5124
Mailing Address - Country:US
Mailing Address - Phone:808-486-4900
Mailing Address - Fax:808-486-4901
Practice Address - Street 1:98-084 KAMEHAMEHA HWY STE 301B
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5124
Practice Address - Country:US
Practice Address - Phone:808-486-4900
Practice Address - Fax:808-486-4901
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-942103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI580474-03Medicaid