Provider Demographics
NPI:1346757283
Name:TAKAHARA, RYOTA (RBT)
Entity Type:Individual
Prefix:MR
First Name:RYOTA
Middle Name:
Last Name:TAKAHARA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 KAPAHULU AVE APT B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-6501
Mailing Address - Country:US
Mailing Address - Phone:808-436-6104
Mailing Address - Fax:
Practice Address - Street 1:41-611 INOAOLE ST
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1211
Practice Address - Country:US
Practice Address - Phone:808-892-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-17-30880106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIRBT-17-30880OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD