Provider Demographics
NPI:1699961730
Name:ANTHONY, SUZANNE MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARY
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARY
Other - Last Name:LOOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 1412
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3301
Mailing Address - Country:US
Mailing Address - Phone:808-295-9905
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:808-295-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-874103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist