Active NPI
Jenny Rebecca Ebesutani, PSY.D.
- Psychologist
- Honolulu, HI
National Provider Identifier
1992957245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 1078
- Practice address
- 1100 Ward Avenue, Suite 665
Honolulu, HI 96814 - Phone
- (808) 304-1565
- Fax
- (808) 599-7900
- NPI assigned
- Oct 17, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 1078 | HI | Primary |
Addresses
Primary practice location
1100 Ward Avenue, Suite 665
Honolulu, HI 96814
Mailing address
PO Box 235665
Honolulu, HI 96823
Phone (808) 304-1565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 1078 | HI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594944000000",
"number": "1992957245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 235665",
"city": "HONOLULU",
"state": "HI",
"postal_code": "96823",
"telephone_number": "808-304-1565",
"fax_number": "808-599-7900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WARD AVENUE, SUITE 665",
"city": "HONOLULU",
"state": "HI",
"postal_code": "96814",
"telephone_number": "808-304-1565",
"fax_number": "808-599-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBESUTANI",
"first_name": "JENNY",
"middle_name": "REBECCA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-17",
"last_updated": "2020-07-17",
"certification_date": "2020-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "HI",
"license": "PSY 1078",
"primary": true
}
],
"identifiers": [],
"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 Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.