NPIMap

Organization Active NPI

Life Master LLC

  • Psychologist
  • Honolulu, HI
National Provider Identifier
1083970545
Registry record updated Apr 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
663 Issued in HI
Legal business name
LIFE MASTER LLC
Practice address
2957 Kalakaua Ave
Suite 601
Honolulu, HI 96815-4650
Phone
(808) 737-6277
NPI assigned
Apr 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mitzi Gold, PH.D, CLSW, MPHNPI 1093750895
Title
Psychologist
Phone
(808) 737-6277

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 663 HI Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 3105 HI

Addresses

Primary practice location

2957 Kalakaua Ave
Suite 601
Honolulu, HI 96815-4650

Mailing address

2957 Kalakaua Avenue
Suite 601
Honolulu, HI 96815
Phone (808) 737-6277

Other identifiers 1

IdentifierTypeStateIssuer
55077401MedicaidHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120629000191 HI Part B Supplier - Clinic/Group Practice 4587829312 Receives reassigned benefits from 1 practitioner
Practice locations: Honolulu, HI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333929600000",
    "number": "1083970545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2957 KALAKAUA AVENUE",
            "address_2": "SUITE 601",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "96815",
            "telephone_number": "808-737-6277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2957 KALAKAUA AVE",
            "address_2": "SUITE 601",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968154650",
            "telephone_number": "808-737-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE MASTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-09",
        "last_updated": "2012-04-09",
        "status": "A",
        "authorized_official_last_name": "GOLD",
        "authorized_official_first_name": "MITZI",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "808-737-6277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D, CLSW, MPH"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "HI",
            "license": "663",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "3105",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55077401",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.