Provider Demographics
NPI:1801506175
Name:BARDSLEY-MARCIAL, KEVIN JOHN
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOHN
Last Name:BARDSLEY-MARCIAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-820 MOANALUA RD
Mailing Address - Street 2:SPACE 5 PMB 161
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5200
Mailing Address - Country:US
Mailing Address - Phone:808-845-6080
Mailing Address - Fax:
Practice Address - Street 1:45-216 PAHIKAUA ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2342
Practice Address - Country:US
Practice Address - Phone:808-429-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician