Provider Demographics
NPI:1356797781
Name:VENDETTI, THOMAS ANTHONY (PHD,LCSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:VENDETTI
Suffix:
Gender:M
Credentials:PHD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 MALAIHI ROAD
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793
Mailing Address - Country:US
Mailing Address - Phone:808-344-1415
Mailing Address - Fax:
Practice Address - Street 1:105 MARKET STREET
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-856-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-4117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health