Provider Demographics
NPI:1306056692
Name:MATSUDA, PAMELA SACHIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SACHIE
Last Name:MATSUDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:SACHIE
Other - Last Name:MATSUDA FRIAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:44-141 HAKO ST
Mailing Address - Street 2:#5
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2511
Mailing Address - Country:US
Mailing Address - Phone:808-387-4023
Mailing Address - Fax:808-234-7379
Practice Address - Street 1:25 KANEOHE BAY DR
Practice Address - Street 2:#204
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1727
Practice Address - Country:US
Practice Address - Phone:808-387-4023
Practice Address - Fax:808-234-7379
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-31761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical