Provider Demographics
NPI:1285860825
Name:CLUTE, JOSHUA MAKAMAE VAUGHN
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MAKAMAE VAUGHN
Last Name:CLUTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-489 NOII PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5915
Mailing Address - Country:US
Mailing Address - Phone:808-699-1548
Mailing Address - Fax:
Practice Address - Street 1:45-489 NOII PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5915
Practice Address - Country:US
Practice Address - Phone:808-699-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH002019391041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool