Provider Demographics
NPI:1588861264
Name:LOMAKA, MARY LOU - (LCSW)
Entity type:Individual
Prefix:
First Name:MARY LOU
Middle Name:-
Last Name:LOMAKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 KAIPII ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2038
Mailing Address - Country:US
Mailing Address - Phone:808-256-2842
Mailing Address - Fax:808-263-2225
Practice Address - Street 1:803 KAMEHAMEHA HWY STE 410
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2638
Practice Address - Country:US
Practice Address - Phone:808-256-2842
Practice Address - Fax:808-263-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-30851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical