=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316000664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIA BRIONES, PH.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2006
-----------------------------------------------------
Last Update Date | 03/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3176 POIPU RD STE 5
-----------------------------------------------------
City | KOLOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96756-9521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-742-6446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5473 PUULIMA RD # C
-----------------------------------------------------
City | KALAHEO
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96741-9301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-742-6446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MARIA BIBIANA BRIONES
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 808-742-6446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY-673
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------