Provider Demographics
NPI:1760044572
Name:GINO, AMANDA MARIA III
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIA
Last Name:GINO
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BISHOP ST STE 2905
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3312
Mailing Address - Country:US
Mailing Address - Phone:808-372-1330
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST STE 2905
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3312
Practice Address - Country:US
Practice Address - Phone:808-372-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI44451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical