Provider Demographics
NPI:1427156991
Name:TREVORROW, TRACY (PHD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:TREVORROW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 KAHAWAI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1618
Mailing Address - Country:US
Mailing Address - Phone:808-782-9542
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:SUITE 1412
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3301
Practice Address - Country:US
Practice Address - Phone:808-782-9542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY549103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI074392Medicaid
HIA20091-3OtherHMSA
HIA20091-3OtherHMSA