Provider Demographics
NPI:1417276239
Name:PLOURDE, ELLIOTT A
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:A
Last Name:PLOURDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 LINAPUNI ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3575
Mailing Address - Country:US
Mailing Address - Phone:808-843-5312
Mailing Address - Fax:808-848-2069
Practice Address - Street 1:1485 LINAPUNI ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3575
Practice Address - Country:US
Practice Address - Phone:808-843-5312
Practice Address - Fax:808-848-2069
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker