Provider Demographics
NPI:1275949976
Name:MATSUSAKA, HARUNA
Entity Type:Individual
Prefix:
First Name:HARUNA
Middle Name:
Last Name:MATSUSAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SOQUEL AVE # 184
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2305
Mailing Address - Country:US
Mailing Address - Phone:510-926-6677
Mailing Address - Fax:
Practice Address - Street 1:325 SOQUEL AVE # 184
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2305
Practice Address - Country:US
Practice Address - Phone:408-317-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI49181041C0700X
CA1000511041C0700X
WA611984131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical