Provider Demographics
NPI:1427194133
Name:MASUTANI, TRAVIS MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:MASUTANI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-001 KAMEHAMEHA HWY STE 217
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3732
Mailing Address - Country:US
Mailing Address - Phone:808-387-7596
Mailing Address - Fax:808-236-3200
Practice Address - Street 1:46-001 KAMEHAMEHA HWY STE 217
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3732
Practice Address - Country:US
Practice Address - Phone:808-387-7596
Practice Address - Fax:808-236-3200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI39831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical