Basic Information
| Provider Information | |||||||||
| NPI: | 1386052017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEHARDY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3083 AKAHI ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082459699 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3083 AKAHI ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082459699 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2014 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BA-107 | HI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1-13-12764 | 01 | BEHAVIOR ANALYST CERTIFICATION BOARD | OTHER | BA-107 | 01 | STATE OF HAWAII | OTHER |