Individual
MAKIKO MATSUOKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
34 DRESSER RD, SCARBOROUGH, ME 04074-9767
(207) 907-9539
Mailing address
PO BOX 6568, SCARBOROUGH, ME 04070-6568
(207) 907-9539
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CC3223
ME
101YP2500X
Professional Counselor
XL2717
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098304
ANTHEM LEGACY NUMBER
ME
05
—
431733799
—
ME
Enumeration date
05/26/2006
Last updated
01/29/2022
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