Provider Demographics
NPI:1023102647
Name:JAQUES, LYNDA H (PSYD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:H
Last Name:JAQUES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 HIIKALA PLACE #5
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5633
Mailing Address - Country:US
Mailing Address - Phone:808-732-7620
Mailing Address - Fax:
Practice Address - Street 1:1833 KALAKAUA AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1512
Practice Address - Country:US
Practice Address - Phone:808-222-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB228078OtherHMSA
HI1039057OtherCIGNA HEALTH CARE
HI501694Medicaid
HI520167OtherHMA SUMMERLIN
HIPSY695OtherQUEENS HEALTH PLANS
HI520167OtherHMA SUMMERLIN
HI501694Medicaid