Provider Demographics
NPI:1962135475
Name:ST ANDREWS, KATELYN MARIE
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARIE
Last Name:ST ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1132 BISHOP ST UNIT 827
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2885
Mailing Address - Country:US
Mailing Address - Phone:518-992-0678
Mailing Address - Fax:
Practice Address - Street 1:1390 MILLER ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2493
Practice Address - Country:US
Practice Address - Phone:518-992-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician