Provider Demographics
NPI:1063865517
Name:FREITAS, EMBER
Entity Type:Individual
Prefix:
First Name:EMBER
Middle Name:
Last Name:FREITAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1037 KAAPEHA ST
Mailing Address - Street 2:APT 258
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4862
Mailing Address - Country:US
Mailing Address - Phone:808-348-4996
Mailing Address - Fax:
Practice Address - Street 1:95-1037 KAAPEHA ST
Practice Address - Street 2:APT 258
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4862
Practice Address - Country:US
Practice Address - Phone:808-348-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician