Provider Demographics
NPI:1912170895
Name:PIZZITOLA, LYNN C
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:PIZZITOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 EGGERKING RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1310
Mailing Address - Country:US
Mailing Address - Phone:808-634-8258
Mailing Address - Fax:
Practice Address - Street 1:195 EGGERKING RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1310
Practice Address - Country:US
Practice Address - Phone:808-634-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-78106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist