Provider Demographics
NPI:1407530504
Name:JOHNSON, JUANITA RHENE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:RHENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MOANALUA RDG
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3936
Mailing Address - Country:US
Mailing Address - Phone:808-305-6000
Mailing Address - Fax:
Practice Address - Street 1:1 MOANALUA RDG
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3936
Practice Address - Country:US
Practice Address - Phone:808-305-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-23-260523106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician