Provider Demographics
NPI:1326608266
Name:PETERSON, LENORE DIANNE
Entity Type:Individual
Prefix:
First Name:LENORE
Middle Name:DIANNE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 KAPIOLANI BOULEVARD
Mailing Address - Street 2:PENTHOUSE 50 & 60
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-260-9893
Mailing Address - Fax:
Practice Address - Street 1:1221 KAPIOLANI BLVD PH 50
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3518
Practice Address - Country:US
Practice Address - Phone:808-260-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI44141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical