Provider Demographics
NPI:1710694047
Name:NAGAMINE, JILL T (RBT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:T
Last Name:NAGAMINE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:T
Other - Last Name:NAGAMINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:1092 HELE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46-169 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3651
Practice Address - Country:US
Practice Address - Phone:808-784-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT18-66856106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician