Provider Demographics
NPI:1912271958
Name:IGNACIO, LAWRIE A (PSYD)
Entity Type:Individual
Prefix:
First Name:LAWRIE
Middle Name:A
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 MAKALOA ST
Mailing Address - Street 2:#204-212
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3232
Mailing Address - Country:US
Mailing Address - Phone:808-286-2112
Mailing Address - Fax:
Practice Address - Street 1:928 NUUANU AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5190
Practice Address - Country:US
Practice Address - Phone:808-286-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical