Provider Demographics
NPI:1992291645
Name:MATHEIS, MAYA NATASSIA (PHD)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:NATASSIA
Last Name:MATHEIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26401
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-6401
Mailing Address - Country:US
Mailing Address - Phone:808-556-7708
Mailing Address - Fax:
Practice Address - Street 1:1164 BISHOP ST STE 929
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2882
Practice Address - Country:US
Practice Address - Phone:808-556-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1979103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical