Provider Demographics
NPI:1134299613
Name:BRITTAIN, MATTHEW D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:BRITTAIN
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:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760-1038
Mailing Address - Country:US
Mailing Address - Phone:808-934-7566
Mailing Address - Fax:808-934-9442
Practice Address - Street 1:56 WAIANUENUE AVE STE 207
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2474
Practice Address - Country:US
Practice Address - Phone:808-934-7566
Practice Address - Fax:808-934-9442
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-30481041C0700X
NV4948-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00B0212197OtherHMSA BLUE CROSS BLUE SHIE
HI24819201Medicaid
HI00B0212197OtherHMSA BLUE CROSS BLUE SHIE