Healthcare Provider Details

I. General information

NPI: 1114864907
Provider Name (Legal Business Name): MARISSA DUCATI GEBHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 SOUTH ST
HONOLULU HI
96813-5013
US

IV. Provider business mailing address

2620 DATE ST APT 8
HONOLULU HI
96826-5670
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-1173
  • Fax:
Mailing address:
  • Phone: 405-697-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1538375
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: