Psychological Service Center, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY Issued in HI

Legal business name

PSYCHOLOGICAL SERVICE CENTER, LLC

Practice address

1135 Makawao Ave
Makawao, HI 96768-7403

Phone

(808) 280-9457

Fax

(808) 572-0311

NPI assigned

Feb 11, 2009

Last updated

Feb 11, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Daniel J Lane, PH.DNPI 1457445934

Title

Chief Psychologist

Phone

(808) 280-9457

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Joseph Lane, PH.D.

  • Psychologist
  • Makawao, HI
  • NPI 1457445934
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234310400000",
    "number": "1194964353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 PENI PL",
            "city": "KULA",
            "state": "HI",
            "postal_code": "967908772",
            "telephone_number": "808-280-9457",
            "fax_number": "808-572-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 MAKAWAO AVE",
            "city": "MAKAWAO",
            "state": "HI",
            "postal_code": "967687403",
            "telephone_number": "808-280-9457",
            "fax_number": "808-572-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL SERVICE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-11",
        "last_updated": "2009-02-11",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF PSYCHOLOGIST",
        "authorized_official_telephone_number": "808-280-9457",
        "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",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "00A0258473",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "57950002",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY HEALTH ALLIANCE",
            "identifier": "548195324",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALOHA CARE QUEST",
            "identifier": "57950000-1",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan M Pirsch, MC - LMFT
• Lisa Beth Ponichtera, PHD, LMFT, CSAC
• Ronda Jean Pope, AMFT
• Monique Abbinanti Popovac, D.C.
• Cristina Elizabeth Prokop, A.P.R.N.
• Pueo Family Practice
• Pukalani Chiropractic Inc
• Pukalani Dental Group, LLP
• Pukalani Dental LLP
• Pukalani Family Practice, LLC

• Clinical Psychologist in Makawao, HI
• Providers in Makawao, HI by specialty
• Clinical Psychologist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2009; 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.