Provider Demographics
NPI:1235699463
Name:BERTOLA, VINNESHA K
Entity Type:Individual
Prefix:
First Name:VINNESHA
Middle Name:K
Last Name:BERTOLA
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 1:1221 KAPIOLANI BLVD PH 50
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3518
Mailing Address - Country:US
Mailing Address - Phone:808-260-9893
Mailing Address - Fax:808-748-0433
Practice Address - Street 1:1221 KAPIOLANI BLVD PH 50
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3518
Practice Address - Country:US
Practice Address - Phone:808-260-9893
Practice Address - Fax:808-748-0433
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health