Provider Demographics
NPI:1174280093
Name:MATTOS, CHANSLEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHANSLEY
Middle Name:
Last Name:MATTOS
Suffix:
Gender:F
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 535
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96771-0535
Mailing Address - Country:US
Mailing Address - Phone:808-756-1041
Mailing Address - Fax:
Practice Address - Street 1:2550 KUHIO AVE APT 2106
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3953
Practice Address - Country:US
Practice Address - Phone:808-756-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-46921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical