Provider Demographics
NPI:1184942849
Name:LISA DUKE PHD LLC
Entity type:Organization
Organization Name:LISA DUKE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-226-8204
Mailing Address - Street 1:92-1017 KOIO DR APT R
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4291
Mailing Address - Country:US
Mailing Address - Phone:808-226-8204
Mailing Address - Fax:808-676-9250
Practice Address - Street 1:1001 KAMOKILA BLVD STE 151
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2090
Practice Address - Country:US
Practice Address - Phone:808-226-8204
Practice Address - Fax:808-676-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1417284514OtherLISA DUKE INDIVIDUAL NPI