Provider Demographics
NPI:1083239560
Name:VASCONCELLOS, SARAH MAILE K
Entity Type:Individual
Prefix:
First Name:SARAH MAILE
Middle Name:K
Last Name:VASCONCELLOS
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 1:91-3439 LUPALUPA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5847
Mailing Address - Country:US
Mailing Address - Phone:808-927-1518
Mailing Address - Fax:
Practice Address - Street 1:91-3439 LUPALUPA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5847
Practice Address - Country:US
Practice Address - Phone:808-927-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-20-122764106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician