Provider Demographics
NPI:1932960341
Name:LISA H GOMES PSYD
Entity Type:Organization
Organization Name:LISA H GOMES PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-783-5770
Mailing Address - Street 1:45-213 NAMOKU ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45-213 NAMOKU ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2230
Practice Address - Country:US
Practice Address - Phone:808-783-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health