Healthcare Provider Details

I. General information

NPI: 1114762671
Provider Name (Legal Business Name): CARESS JOY REILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 MILLER ST
HONOLULU HI
96813-2493
US

IV. Provider business mailing address

888 MURRAY DR
HONOLULU HI
96818-3721
US

V. Phone/Fax

Practice location:
  • Phone: 808-586-4997
  • Fax:
Mailing address:
  • Phone: 202-790-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: