Provider Demographics
NPI:1134381403
Name:SCHNACKENBERG, CORA LINN (MA)
Entity type:Individual
Prefix:MS
First Name:CORA
Middle Name:LINN
Last Name:SCHNACKENBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CORA
Other - Middle Name:LINN
Other - Last Name:CAPARIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0222
Mailing Address - Country:US
Mailing Address - Phone:808-352-5892
Mailing Address - Fax:
Practice Address - Street 1:HC01 841D KAMEHAMEHA HIGHWAY
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-0222
Practice Address - Country:US
Practice Address - Phone:808-352-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106H00000X106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI6487OtherCAMHD CREDENTIALING COMMITTEE