Provider Demographics
NPI:1013502863
Name:CANNAMELA, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:CANNAMELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:BRIERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91-1272 KAILEOLEA DR
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6274
Mailing Address - Country:US
Mailing Address - Phone:443-994-9563
Mailing Address - Fax:
Practice Address - Street 1:91-1272 KAILEOLEA DR
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6274
Practice Address - Country:US
Practice Address - Phone:443-994-9563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN56571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical