Provider Demographics
NPI:1679795470
Name:TWENTYMAN, CRAIG T (PHD, LAC, CSAC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:T
Last Name:TWENTYMAN
Suffix:
Gender:M
Credentials:PHD, LAC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 NUUANU AVENUE
Mailing Address - Street 2:2201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4011
Mailing Address - Country:US
Mailing Address - Phone:808-591-2345
Mailing Address - Fax:
Practice Address - Street 1:100 N. BERETANIA STREET
Practice Address - Street 2:208
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4709
Practice Address - Country:US
Practice Address - Phone:808-591-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI324103T00000X
HI799171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07244501Medicaid
HIH55165Medicare ID - Type UnspecifiedPRACTICE ID NUMBER