Provider Demographics
NPI:1225232663
Name:VANDENBERG, BARBARA JOANNE (RBT)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JOANNE
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:JOANNE
Other - Last Name:KIELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CADC II, NCAC II
Mailing Address - Street 1:47-497 WAIPUA PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5446
Mailing Address - Country:US
Mailing Address - Phone:808-256-4035
Mailing Address - Fax:
Practice Address - Street 1:55-109 KULANUI ST
Practice Address - Street 2:
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762-1214
Practice Address - Country:US
Practice Address - Phone:808-293-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-19-90553106S00000X
OR94-02-26101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1639359367Medicaid