Provider Demographics
NPI:1194801951
Name:WASSMAN, AMY KG (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:KG
Last Name:WASSMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:K
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 BISHOP ST STE 2870
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3482
Mailing Address - Country:US
Mailing Address - Phone:808-726-0750
Mailing Address - Fax:707-948-6036
Practice Address - Street 1:1001 BISHOP ST STE 2870
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3482
Practice Address - Country:US
Practice Address - Phone:808-726-0750
Practice Address - Fax:707-948-6036
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN