Provider Demographics
NPI:1588872790
Name:GRANOFF, SIM E (PHD (PSYCHOLOGY))
Entity type:Individual
Prefix:DR
First Name:SIM
Middle Name:E
Last Name:GRANOFF
Suffix:
Gender:M
Credentials:PHD (PSYCHOLOGY)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-973 WIKAO ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3966
Mailing Address - Country:US
Mailing Address - Phone:808-627-0608
Mailing Address - Fax:808-627-0608
Practice Address - Street 1:95-973 WIKAO ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3966
Practice Address - Country:US
Practice Address - Phone:808-627-0608
Practice Address - Fax:808-627-0608
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI00118103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)