Provider Demographics
NPI:1558511170
Name:MENDONCA, DENNIS (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:MENDONCA
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3956
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-6956
Mailing Address - Country:US
Mailing Address - Phone:808-652-2505
Mailing Address - Fax:
Practice Address - Street 1:6538 KAHUNA RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-9130
Practice Address - Country:US
Practice Address - Phone:808-652-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist