Provider Demographics
NPI:1649475286
Name:AMADORA, MARY ANN MIDORI (MSCP)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:MIDORI
Last Name:AMADORA
Suffix:
Gender:F
Credentials:MSCP
Other - Prefix:MS
Other - First Name:MARY ANN
Other - Middle Name:MIDORI
Other - Last Name:YONASHIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCP
Mailing Address - Street 1:6147 KAWEKIU PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2222
Mailing Address - Country:US
Mailing Address - Phone:808-963-8003
Mailing Address - Fax:808-396-5566
Practice Address - Street 1:1100 ALAKEA ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2833
Practice Address - Country:US
Practice Address - Phone:808-523-7771
Practice Address - Fax:808-523-5990
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst