Provider Demographics
NPI:1144468901
Name:KANESHIRO, MATHEW K (LMFT)
Entity type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:K
Last Name:KANESHIRO
Suffix:
Gender:M
Credentials:LMFT
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 8164
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34290-8164
Mailing Address - Country:US
Mailing Address - Phone:808-276-2758
Mailing Address - Fax:
Practice Address - Street 1:2403 HONEY LN
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-2407
Practice Address - Country:US
Practice Address - Phone:808-276-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-31
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1144468901Medicaid