NPIMap

Organization Active NPI

Jackie Guadagnoli, PH.D.

  • Clinical Psychologist
  • Kapaa, HI
National Provider Identifier
1114190873
Registry record updated Apr 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY-817 Issued in HI
Legal business name
JACKIE GUADAGNOLI, PH.D.
Practice address
4-1558 Kuhio Hwy
Kapaa, HI 96746-1856
Phone
(808) 392-1111
Fax
(808) 245-8762
NPI assigned
Apr 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2008

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

Authorized official

Name
Dr. Jackie Guadagnoli, PH.D.
Title
Psychologist
Phone
(808) 392-1111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY-817 HI Primary

Addresses

Primary practice location

4-1558 Kuhio Hwy
Kapaa, HI 96746-1856

Mailing address

4-1558 Kuhio Hwy
Kapaa, HI 96746-1856
Phone (808) 392-1111

Other identifiers 1

IdentifierTypeStateIssuer
55079017MedicaidHI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1114190873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4-1558 KUHIO HWY",
            "city": "KAPAA",
            "state": "HI",
            "postal_code": "967461856",
            "telephone_number": "808-392-1111",
            "fax_number": "808-245-8762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4-1558 KUHIO HWY",
            "city": "KAPAA",
            "state": "HI",
            "postal_code": "967461856",
            "telephone_number": "808-392-1111",
            "fax_number": "808-245-8762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKIE GUADAGNOLI, PH.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "GUADAGNOLI",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "808-392-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "PSY-817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55079017",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kapaa, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.