Provider Demographics
NPI:1164592598
Name:LEE, PRISCILLA T (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:T
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WAIANUENUE AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2474
Mailing Address - Country:US
Mailing Address - Phone:808-969-9211
Mailing Address - Fax:808-969-9211
Practice Address - Street 1:56 WAIANUENUE AVE STE 208
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2474
Practice Address - Country:US
Practice Address - Phone:808-969-9211
Practice Address - Fax:808-969-9211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI32521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000228148OtherHMSA QUEST
HI492405-01OtherALOHA CARE
HI569147-01Medicaid
HI990189021OtherTRIWEST HEALTH ALLIANCE
HI0000228148OtherHMSA COMMERCIAL
HI0601130012OtherHMAA
HI990189021OtherTRIWEST HEALTH ALLIANCE