Active NPI
Susan J Licoan, PSYD
- Clinical Psychologist
- Ookala, HI
National Provider Identifier
1003117268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1214
- Practice address
- 39 3301 Milo Place
Ookala, HI 96774 - Phone
- (808) 896-7186
- Fax
- (808) 962-6943
- NPI assigned
- Nov 4, 2010
- Last updated
- May 12, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1214 | HI | Primary |
Addresses
Primary practice location
39 3301 Milo Place
Ookala, HI 96774
Mailing address
PO Box 1578
Honokaa, HI 96727-1578
Phone (808) 896-7186
Other names 1
- Mrs. Susan J Smith
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001128 | IA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368316800000",
"number": "1003117268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1578",
"city": "HONOKAA",
"state": "HI",
"postal_code": "967271578",
"telephone_number": "808-896-7186",
"fax_number": "808-962-6943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39 3301 MILO PLACE",
"city": "OOKALA",
"state": "HI",
"postal_code": "96774",
"telephone_number": "808-896-7186",
"fax_number": "808-962-6943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICOAN",
"first_name": "SUSAN",
"middle_name": "J",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-04",
"last_updated": "2013-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "HI",
"license": "1214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "SMITH",
"middle_name": "J",
"prefix": "MRS.",
"code": "1",
"type": "Former Name"
}
]
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.