Provider Demographics
NPI:1356758908
Name:YAMADA, MARITESS M (MFT)
Entity type:Individual
Prefix:
First Name:MARITESS
Middle Name:M
Last Name:YAMADA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARITESS
Other - Middle Name:
Other - Last Name:MACARAEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:94-828 LUMIAUAU ST
Mailing Address - Street 2:M204
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4861
Mailing Address - Country:US
Mailing Address - Phone:808-354-2187
Mailing Address - Fax:
Practice Address - Street 1:94-828 LUMIAUAU ST
Practice Address - Street 2:M204
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-354-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2018-06-16
Deactivation Date:2018-05-30
Deactivation Code:
Reactivation Date:2018-06-06
Provider Licenses
StateLicense IDTaxonomies
HIMFT-563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty