Provider Demographics
NPI:1730425588
Name:MACHATE, JENNIFER P (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:MACHATE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:MACHATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:266 ALAUME STREET
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:808-283-9497
Mailing Address - Fax:
Practice Address - Street 1:266 ALAUME ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8515
Practice Address - Country:US
Practice Address - Phone:808-283-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW3820104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker