Provider Demographics
NPI:1750979753
Name:PROBERT, VANESSA RENE (RBT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENE
Last Name:PROBERT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 LOWER HONOAPIILANI RD
Mailing Address - Street 2:BUILDING C APT 2
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761
Mailing Address - Country:US
Mailing Address - Phone:808-868-6276
Mailing Address - Fax:
Practice Address - Street 1:553 WAINEE ST
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1109
Practice Address - Country:US
Practice Address - Phone:808-868-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-21-150285106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician