Provider Demographics
NPI:1457764003
Name:BENJAMIN, KATHRYN (BA THEATRE ARTS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:BA THEATRE ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1841 FORT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1909
Mailing Address - Country:US
Mailing Address - Phone:808-681-3500
Mailing Address - Fax:808-681-1486
Practice Address - Street 1:1045 KILAUEA AVE
Practice Address - Street 2:#A
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4291
Practice Address - Country:US
Practice Address - Phone:808-935-2188
Practice Address - Fax:808-961-2073
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator