Provider Demographics
NPI:1013302835
Name:MATUTINO, ANGELIQUE (LMFT)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:MATUTINO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANGELIQUE
Other - Middle Name:
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45-845 POOKELA ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5700
Mailing Address - Country:US
Mailing Address - Phone:808-447-5261
Mailing Address - Fax:808-236-2626
Practice Address - Street 1:45-845 POOKELA ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5700
Practice Address - Country:US
Practice Address - Phone:808-447-5261
Practice Address - Fax:808-236-2626
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist