Provider Demographics
NPI:1114413739
Name:GONSALES, CLEOPATRA SAVELLA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:CLEOPATRA
Middle Name:SAVELLA
Last Name:GONSALES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:CLEO
Other - Middle Name:SAVELLA
Other - Last Name:GONSALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:200 N VINEYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N VINEYARD BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3950
Practice Address - Country:US
Practice Address - Phone:808-523-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-18-59789103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst