Individual provider Active NPI

Kathleen Marianne McNamara, PH.D.

  • Clinical Psychologist
  • Wailuku, HI
National Provider Identifier
1790772093
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY408 Issued in HI
Practice address
1129 Lower Main St
Suite 305
Wailuku, HI 96793-2053
Phone
(808) 876-0098
Fax
(808) 878-8908
NPI assigned
Oct 2, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY 408 HI
Clinical Psychologist 103TC0700X PSY408 HI Primary

Addresses

Primary practice location

1129 Lower Main St
Suite 305
Wailuku, HI 96793-2053

Mailing address

PO Box 330489
Kahului, HI 96733-0489
Phone (808) 876-0098

Other identifiers 2

IdentifierTypeStateIssuer
061555 01MedicaidHI
08180OtherHIHMSA PROVIDER ROOT NUMBER

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 408HIMDClinical Neuropsychologist
PSY408HIMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1128211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196726400000",
    "number": "1790772093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 330489",
            "city": "KAHULUI",
            "state": "HI",
            "postal_code": "967330489",
            "telephone_number": "808-876-0098",
            "fax_number": "808-878-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 LOWER MAIN ST",
            "address_2": "SUITE 305",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932053",
            "telephone_number": "808-876-0098",
            "fax_number": "808-878-8908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNAMARA",
        "first_name": "KATHLEEN",
        "middle_name": "MARIANNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-02",
        "last_updated": "2007-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "HI",
            "license": "PSY 408",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "PSY408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "061555 01",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA PROVIDER ROOT NUMBER",
            "identifier": "08180",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; 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.