Basic Information
| Provider Information | |||||||||
| NPI: | 1043893241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AKAMAI BEHAVIOR ANALYSIS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 HOOWAIWAI LOOP APT 2606 | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967934132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082762417 | ||||||||
| FaxNumber: | 8084229816 | ||||||||
| Practice Location | |||||||||
| Address1: | 139 HOOWAIWAI LOOP APT 2606 | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967934132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082762417 | ||||||||
| FaxNumber: | 8084229816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2021 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | FRANK | ||||||||
| AuthorizedOfficialFirstName: | MATHEW | ||||||||
| AuthorizedOfficialMiddleName: | EVAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8082762417 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | ED.S. | ||||||||
| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | Y | Agencies | Day Training, Developmentally Disabled Services |
ID Information
| ID | Type | State | Issuer | Description | 251C00000X | 05 | HI | MEDICAID |