Provider Demographics
NPI:1992957245
Name:EBESUTANI, JENNY REBECCA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:REBECCA
Last Name:EBESUTANI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235665
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823
Mailing Address - Country:US
Mailing Address - Phone:808-304-1565
Mailing Address - Fax:808-599-7900
Practice Address - Street 1:1100 WARD AVENUE, SUITE 665
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-304-1565
Practice Address - Fax:808-599-7900
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1078103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist