Provider Demographics
NPI:1477601813
Name:ITOH, MAKI (MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:MAKI
Middle Name:
Last Name:ITOH
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 OXFORD ST APT C
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1654
Mailing Address - Country:US
Mailing Address - Phone:510-867-0952
Mailing Address - Fax:
Practice Address - Street 1:1694 OXFORD ST APT C
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1654
Practice Address - Country:US
Practice Address - Phone:510-867-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT INTERN # 45235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health