Healthcare Provider Details

I. General information

NPI: 1639775810
Provider Name (Legal Business Name): BROOKE MASER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KAPAA QUARRY PL #5002
KAILUA HI
96734
US

IV. Provider business mailing address

1002B KOOHOO PL
KAILUA HI
96734-3273
US

V. Phone/Fax

Practice location:
  • Phone: 808-741-2232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-943-0
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-14996
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: