Provider Demographics
NPI:1871721506
Name:CHURCH, MARY BARBARA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:BARBARA
Last Name:CHURCH
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 COCONUT AVE APT 5H
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-4752
Mailing Address - Country:US
Mailing Address - Phone:808-479-7670
Mailing Address - Fax:808-645-4856
Practice Address - Street 1:2801 COCONUT AVE APT 5H
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-4752
Practice Address - Country:US
Practice Address - Phone:808-479-7670
Practice Address - Fax:808-645-4856
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical