Provider Demographics
NPI:1912474255
Name:TAKENAKA, LIANE (RBT)
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:
Last Name:TAKENAKA
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 1:1720 POKI ST APT 206
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4499
Mailing Address - Country:US
Mailing Address - Phone:808-221-9132
Mailing Address - Fax:
Practice Address - Street 1:1720 POKI ST APT 206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-4499
Practice Address - Country:US
Practice Address - Phone:808-221-9132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-16-11904106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician