Provider Demographics
NPI:1326755380
Name:BARBUT, ERIC MARK
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MARK
Last Name:BARBUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-402 HAONA ST
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-9613
Mailing Address - Country:US
Mailing Address - Phone:808-436-6630
Mailing Address - Fax:
Practice Address - Street 1:HIGHLANDS INTERMEDIATE SCHOOL
Practice Address - Street 2:1460 HO'OLAULE'A ST.
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782
Practice Address - Country:US
Practice Address - Phone:808-307-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-20-110516106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician