Individual provider Active NPI

Maria Petkus

  • Clinical Psychologist
  • Honolulu, HI
National Provider Identifier
1982062691
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2207 Issued in HI
Practice address
1441 Kapiolani Blvd Ste 1802
Honolulu, HI 96814-4408
Phone
(808) 525-6255
NPI assigned
Feb 9, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2207 HI Primary

Addresses

Primary practice location

1441 Kapiolani Blvd Ste 1802
Honolulu, HI 96814-4408

Mailing address

516 Mananai PL Apt a
Honolulu, HI 96818-5338
Phone (831) 236-2501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241121001296 HI Practitioner - Clinical Psychologist 3375078827 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
I Ola Lahui IncGroup PAC ID 0345420972, 6 clinicians

Practice addresses (Care Compare)

1441 Kapiolani Blvd
Suite 1802
Honolulu, HI 96814-4408
Phone (808) 525-6255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2207HIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Maria Petkus PHD, LLC CurrentSince Mar 24, 2025 Accepting new patients
I Ola Lahui Inc Clinical CurrentSince Sep 16, 2024 Accepting new patients
Goodwill Industries of Santa Clara County Past Accepting new patients

Locations

1441 Kapiolani Blvd
Ste 1802
Honolulu, HI 96814
Phone (808) 525-6234

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1982062691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 MANANAI PL APT A",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968185338",
            "telephone_number": "831-236-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 KAPIOLANI BLVD STE 1802",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968144408",
            "telephone_number": "808-525-6255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETKUS",
        "first_name": "MARIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-09",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "2207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.