Provider Demographics
NPI:1700413051
Name:NICOLE AURELLANO, PSYD, LLC
Entity Type:Organization
Organization Name:NICOLE AURELLANO, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MR
Authorized Official - Last Name:AURELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-348-1553
Mailing Address - Street 1:92-1295 HOOKEHA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1572
Mailing Address - Country:US
Mailing Address - Phone:808-348-1553
Mailing Address - Fax:
Practice Address - Street 1:91-1010 SHANGRILA ST STE 307
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2176
Practice Address - Country:US
Practice Address - Phone:808-348-1553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty