Provider Demographics
NPI:1548639685
Name:SIERRA, DENNISE
Entity type:Individual
Prefix:
First Name:DENNISE
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KAHELU AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3913
Mailing Address - Country:US
Mailing Address - Phone:808-625-3000
Mailing Address - Fax:808-625-3006
Practice Address - Street 1:100 KAHELU AVE STE 110
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3913
Practice Address - Country:US
Practice Address - Phone:808-625-3000
Practice Address - Fax:808-625-3006
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-21-48278103K00000X
222Q00000X
HIBA-511-0103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty