Provider Demographics
NPI:1750358537
Name:LENZ, JOSEPH W (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:LENZ
Suffix:
Gender:M
Credentials:PHD
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 1719
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1719
Mailing Address - Country:US
Mailing Address - Phone:808-232-9515
Mailing Address - Fax:833-520-5013
Practice Address - Street 1:2086 LILIKOI RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5043
Practice Address - Country:US
Practice Address - Phone:808-232-9515
Practice Address - Fax:833-520-5013
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002351103TC0700X
HIPSY-1207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ25801Medicare UPIN
WA8807997Medicare PIN