Provider Demographics
NPI:1376719294
Name:KOMORI, LORI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:KOMORI
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 1:1525 WILDER AVE PH 7
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4687
Mailing Address - Country:US
Mailing Address - Phone:808-392-1218
Mailing Address - Fax:
Practice Address - Street 1:1525 WILDER AVE PH 7
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-4687
Practice Address - Country:US
Practice Address - Phone:808-392-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical