Provider Demographics
NPI:1689415325
Name:DOMENDEN, ARNOLD R
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:R
Last Name:DOMENDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EAST VINEYARD ROAD #43
Mailing Address - Street 2:105
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:808-372-0485
Mailing Address - Fax:
Practice Address - Street 1:1867 E VINEYARD ST STE 2
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1847
Practice Address - Country:US
Practice Address - Phone:808-372-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-24-349336106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician