Provider Demographics
NPI:1841418548
Name:AMBROSINO HO, LISA WAI MUI (PSYD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:WAI MUI
Last Name:AMBROSINO HO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:WAI MUI
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 12068
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96828-1068
Mailing Address - Country:US
Mailing Address - Phone:808-356-9435
Mailing Address - Fax:866-757-6564
Practice Address - Street 1:1833 KALAKAUA AVE STE 206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1500
Practice Address - Country:US
Practice Address - Phone:808-356-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1512103TC0700X
CAPSY25542103TC0700X
HIPSY 1512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical