Basic Information
| Provider Information | |||||||||
| NPI: | 1598161671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POSITIVE BEHAVIORAL INTERVENTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 614 COOKE ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087793566 | ||||||||
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| Practice Location | |||||||||
| Address1: | 614 COOKE ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087793566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2014 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | JOELLE | ||||||||
| AuthorizedOfficialMiddleName: | ILIMA MEI-LIN | ||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIOR ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 8087793566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.ED. BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 1118832 | HI | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1851664957 | 01 | HI | TRICARE | OTHER |