Provider Demographics
NPI:1194509679
Name:GOUVEIA, CASSIE KEHAULANI
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:KEHAULANI
Last Name:GOUVEIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:KEHAULANI
Other - Last Name:GOUVEIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:87-138 KAUKAMANA ST
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3102
Mailing Address - Country:US
Mailing Address - Phone:808-219-9497
Mailing Address - Fax:
Practice Address - Street 1:HAWAII DOE 1390 MILLER STREET
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-784-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician