Organization
LIFE MASTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITZI GOLD PH.D, CLSW, MPH (PSYCHOLOGIST)
(808) 737-6277
Entity
Organization
Contact information
Practice address
2957 KALAKAUA AVE, SUITE 601, HONOLULU, HI 96815-4650
(808) 737-6277
Mailing address
2957 KALAKAUA AVENUE, SUITE 601, HONOLULU, HI 96815
(808) 737-6277
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
663
HI
1041C0700X
Clinical Social Worker
3105
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55077401
—
HI
Enumeration date
04/09/2012
Last updated
04/09/2012
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