Provider Demographics
NPI:1932487733
Name:ADDEO PLUMB, LISA (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ADDEO PLUMB
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51-019 LAU PL
Mailing Address - Street 2:
Mailing Address - City:KAAAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96730-9817
Mailing Address - Country:US
Mailing Address - Phone:949-903-8963
Mailing Address - Fax:
Practice Address - Street 1:51-019 LAU PL
Practice Address - Street 2:
Practice Address - City:KAAAWA
Practice Address - State:HI
Practice Address - Zip Code:96730-9817
Practice Address - Country:US
Practice Address - Phone:949-903-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist