Provider Demographics
NPI:1275866758
Name:NAGAMINE, JON M (MSCP)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:M
Last Name:NAGAMINE
Suffix:
Gender:M
Credentials:MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-452 PAPIPI DR
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2317
Mailing Address - Country:US
Mailing Address - Phone:808-479-4327
Mailing Address - Fax:808-689-1242
Practice Address - Street 1:91-452 PAPIPI DR
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2317
Practice Address - Country:US
Practice Address - Phone:808-479-4327
Practice Address - Fax:808-689-1242
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health