Basic Information
| Provider Information | |||||||||
| NPI: | 1578029484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEGRILLO | ||||||||
| FirstName: | CLAIRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 706 HOOLUU ST | ||||||||
| Address2: | |||||||||
| City: | PEARL CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967822144 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 99-870 IWAENA ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967013278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082777736 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2019 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | 19-77412 | HI | N | 106S00000X | Y |
ID Information
| ID | Type | State | Issuer | Description | H01488381 | 01 | HI | NOT APPLICABLE | OTHER |