Provider Demographics
NPI:1730509126
Name:CANILLO, ASHLEY (BA PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CANILLO
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 S PAPA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1928
Mailing Address - Country:US
Mailing Address - Phone:808-385-4532
Mailing Address - Fax:
Practice Address - Street 1:628 S PAPA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1928
Practice Address - Country:US
Practice Address - Phone:808-385-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health