Provider Demographics
NPI:1992827463
Name:MATSUI, SHANE TASHIRO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:TASHIRO
Last Name:MATSUI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1912
Mailing Address - Country:US
Mailing Address - Phone:213-738-2824
Mailing Address - Fax:213-427-6166
Practice Address - Street 1:550 SOUTH VERMONT AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020
Practice Address - Country:US
Practice Address - Phone:213-738-2824
Practice Address - Fax:213-427-6166
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker