Provider Demographics
NPI:1962595678
Name:BAILEY, FAHY (PHD)
Entity type:Individual
Prefix:DR
First Name:FAHY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
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:P.O. BOX 657
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-0657
Mailing Address - Country:US
Mailing Address - Phone:808-822-2447
Mailing Address - Fax:808-821-0136
Practice Address - Street 1:4-1435 KUHIO HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1745
Practice Address - Country:US
Practice Address - Phone:808-822-2447
Practice Address - Fax:808-821-0136
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 345103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02390202Medicaid
0000TCBLQMedicare ID - Type Unspecified
HI02390202Medicaid
HIR17962Medicare UPIN