Doctor Name: | MAKIKO MATSUOKA |
NPI Number: | 1003862160 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC-C |
License Number: | XL2717 |
Business Practice Address: | 22 Merchants Plz Bangor, ME - 044016349 |
Business Phone Number: | 2079423816 |
Business Fax Number: | 2075614725 |
Mailing Address: | 29 Franklin St, BANGOR |
State: | ME |
Postal Code: | 044014909 |
Phone Number: | 2079423816 |
Fax Number: | 2075614725 |
NPI Enumeration Date: | 05/26/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | XL2717 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |