Provider Demographics
NPI:1114250693
Name:JUAREZ, ADI E (LMFT)
Entity Type:Individual
Prefix:
First Name:ADI
Middle Name:E
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ADI
Other - Middle Name:
Other - Last Name:LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2695 S KIHEI RD APT 10201
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8673
Mailing Address - Country:US
Mailing Address - Phone:808-495-9371
Mailing Address - Fax:
Practice Address - Street 1:2695 S KIHEI RD APT 10201
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8673
Practice Address - Country:US
Practice Address - Phone:808-495-9371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00182600106H00000X
NY001214-1106H00000X
CA62007106H00000X
HI627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist