Provider Demographics
NPI:1326440116
Name:AURELLANO, NICOLE MARIE ROBELLO (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE ROBELLO
Last Name:AURELLANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:ROBELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:92-1295 HOOKEHA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1572
Mailing Address - Country:US
Mailing Address - Phone:808-348-1553
Mailing Address - Fax:
Practice Address - Street 1:41-1347 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1247
Practice Address - Country:US
Practice Address - Phone:808-259-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPSY- 1489OtherLICENSE NUMBER