Provider Demographics
NPI:1447460340
Name:LEVISTER, RAYMOND LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LEE
Last Name:LEVISTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:445 SEASIDE AVE
Mailing Address - Street 2:# 2518
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2640
Mailing Address - Country:US
Mailing Address - Phone:808-489-5558
Mailing Address - Fax:808-585-0379
Practice Address - Street 1:210 WARD AVE
Practice Address - Street 2:#124
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4008
Practice Address - Country:US
Practice Address - Phone:808-489-5558
Practice Address - Fax:808-585-0379
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-823103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI990339751-96813-B004OtherTRICARE
HI0000246991OtherHMSA