1306056692 NPI number — MS. PAMELA SACHIE MATSUDA LCSW

Table of content: MS. PAMELA SACHIE MATSUDA LCSW (NPI 1306056692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306056692 NPI number — MS. PAMELA SACHIE MATSUDA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATSUDA
Provider First Name:
PAMELA
Provider Middle Name:
SACHIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATSUDA FRIAR
Provider Other First Name:
PAMELA
Provider Other Middle Name:
SACHIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306056692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44-141 HAKO ST
Provider Second Line Business Mailing Address:
#5
Provider Business Mailing Address City Name:
KANEOHE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96744-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-387-4023
Provider Business Mailing Address Fax Number:
808-234-7379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 KANEOHE BAY DR
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-387-4023
Provider Business Practice Location Address Fax Number:
808-234-7379
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW-3176 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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