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General NPI Number Information
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NPI Number | 1356797781
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Entity Type | Individual
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Provider Name | THOMAS ANTHONY VENDETTI PH.D.,LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 105 MARKET STREET
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City | WAILUKU
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State | HI
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Zip | 96793
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Country | US
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Telephone | 808-856-8004
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Fax |
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Provider Business Mailing Address
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Address Line | 1147 MALAIHI ROAD
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City | WAILUKU
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State | HI
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Zip | 96793
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Country | US
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Telephone | 808-344-1415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW-4117
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License Number State | HI
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