Provider Demographics
NPI:1568095586
Name:COLLABORATIVE HEALTH PROMOTION
Entity Type:Organization
Organization Name:COLLABORATIVE HEALTH PROMOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VILMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-257-4247
Mailing Address - Street 1:1221 KAPIOLANI BLVD
Mailing Address - Street 2:PENTHOUSE 50 & 60
Mailing Address - City:HONLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 KAPIOLANI BLVD
Practice Address - Street 2:PENTHOUSE 50 & 60
Practice Address - City:HONLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-260-9893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health