Active NPI
Sheree D Revilla, MFT, CSAC, CADC
- Marriage & Family Therapist
- Kailua, HI
National Provider Identifier
1699080390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 253
- Practice address
- 354 Uluniu St
Suite 412
Kailua, HI 96734-2528 - Phone
- (808) 284-4104
- NPI assigned
- Aug 18, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1434-09 | HI | |
| Marriage & Family Therapist | 106H00000X | 253 | HI | Primary |
Addresses
Primary practice location
354 Uluniu St
Suite 412
Kailua, HI 96734-2528
Mailing address
1600 Kapiolani Blvd
Suite 1306
Honolulu, HI 96814-3801
Phone (808) 284-4104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1434-09 | HI | MD | Addiction (Substance Use Disorder) Counselor |
| 253 | HI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341619200000",
"number": "1699080390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 KAPIOLANI BLVD",
"address_2": "SUITE 1306",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968143801",
"telephone_number": "808-284-4104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "354 ULUNIU ST",
"address_2": "SUITE 412",
"city": "KAILUA",
"state": "HI",
"postal_code": "967342528",
"telephone_number": "808-284-4104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVILLA",
"first_name": "SHEREE",
"middle_name": "D",
"credential": "MFT, CSAC, CADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-18",
"last_updated": "2012-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "HI",
"license": "1434-09",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "HI",
"license": "253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kailua, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.