Provider Demographics
NPI:1295010205
Name:KAMADA, MARISA MISAE (LMFT)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:MISAE
Last Name:KAMADA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WYLLIE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1308
Mailing Address - Country:US
Mailing Address - Phone:808-779-2575
Mailing Address - Fax:
Practice Address - Street 1:438 HOBRON LN STE 315
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1229
Practice Address - Country:US
Practice Address - Phone:808-779-2575
Practice Address - Fax:808-888-3809
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist