Provider Demographics
NPI:1366268088
Name:MARISA LLOYD, LLC
Entity type:Organization
Organization Name:MARISA LLOYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC
Authorized Official - Phone:808-284-1169
Mailing Address - Street 1:460 ENA RD STE 505
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1774
Mailing Address - Country:US
Mailing Address - Phone:415-320-6697
Mailing Address - Fax:
Practice Address - Street 1:460 ENA RD STE 505
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1774
Practice Address - Country:US
Practice Address - Phone:415-320-6697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)