Provider Demographics
NPI:1871766352
Name:LIDEN, SHARON RAE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:RAE
Last Name:LIDEN
Suffix:
Gender:F
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:PO BOX 631138
Mailing Address - Street 2:272 LANAI AVENUE
Mailing Address - City:LANAI CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96763-1138
Mailing Address - Country:US
Mailing Address - Phone:808-649-0032
Mailing Address - Fax:
Practice Address - Street 1:272 LANAI AVE.
Practice Address - Street 2:
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763
Practice Address - Country:US
Practice Address - Phone:808-649-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-16129103TC0700X
CAMFC32157106H00000X
HIMFT-81106H00000X
HIPSY-1779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist