Provider Demographics
NPI:1679906747
Name:BAINBRIDGE, JACOB (MA)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:BAINBRIDGE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 IPULEI PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3508
Mailing Address - Country:US
Mailing Address - Phone:808-377-0108
Mailing Address - Fax:
Practice Address - Street 1:45-021 LIKEKE PLACE
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-235-1377
Practice Address - Fax:808-235-1074
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist