Basic Information
| Provider Information | |||||||||
| NPI: | 1447460340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVISTER | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 SEASIDE AVE | ||||||||
| Address2: | # 2518 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968152640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084895558 | ||||||||
| FaxNumber: | 8085850379 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 WARD AVE | ||||||||
| Address2: | #124 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968144008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084895558 | ||||||||
| FaxNumber: | 8085850379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 04/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY-823 | HI | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 990339751-96813-B004 | 01 | HI | TRICARE | OTHER | 0000246991 | 01 | HI | HMSA | OTHER |