Basic Information
| Provider Information | |||||||||
| NPI: | 1336661727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | CASTALDO | ||||||||
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| Credential: | BCBA 1-17-28098 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4510 SALT LAKE BLVD STE D8 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968183172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084861804 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4510 SALT LAKE BLVD | ||||||||
| Address2: | D-8 | ||||||||
| City: | HONLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084861804 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1942689526 | 05 | HI | MEDICAID |