Provider Demographics
NPI:1962150375
Name:SIMON, HALEY (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1054 PAHA PL # N1
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4458
Mailing Address - Country:US
Mailing Address - Phone:808-954-5815
Mailing Address - Fax:
Practice Address - Street 1:1330 ALAMOANA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-585-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty