Provider Demographics
NPI:1518707215
Name:PENNUTO, DEBBIE LYNN (CSAC)
Entity type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:LYNN
Last Name:PENNUTO
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1474 WAHANE ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3114
Mailing Address - Country:US
Mailing Address - Phone:808-807-7413
Mailing Address - Fax:
Practice Address - Street 1:47-388 HUI IWA ST STE 14
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4427
Practice Address - Country:US
Practice Address - Phone:808-399-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)