Active NPI
Carissa Thibodeaux, RBT
- Behavior Technician
- Honolulu, HI
National Provider Identifier
1861002479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB594819
- Practice address
- 500 Ala Moana Blvd Ste 7400
Honolulu, HI 96813-4902 - Phone
- (808) 354-0090
- NPI assigned
- Aug 7, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | BACB594819 | HI | Primary |
Addresses
Primary practice location
500 Ala Moana Blvd Ste 7400
Honolulu, HI 96813-4902
Mailing address
2649 Varsity PL Apt 212
Honolulu, HI 96826-1640
Phone (808) 793-8773
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 |
|---|---|---|---|
| BACB594819 | HI | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596758400000",
"number": "1861002479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2649 VARSITY PL APT 212",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968261640",
"telephone_number": "808-793-8773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 ALA MOANA BLVD STE 7400",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968134902",
"telephone_number": "808-354-0090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIBODEAUX",
"first_name": "CARISSA",
"credential": "RBT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-07",
"last_updated": "2020-08-07",
"certification_date": "2020-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "HI",
"license": "BACB594819",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.