Provider Demographics
NPI:1417621657
Name:PALACAT, SUZANNE (RBT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:PALACAT
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 1:725 CALIFORNIA AVE APT B
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1920
Mailing Address - Country:US
Mailing Address - Phone:808-389-2602
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2096
Practice Address - Country:US
Practice Address - Phone:808-951-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20-136259106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician