Provider Demographics
NPI:1467627075
Name:SMITH, MARGARET BUBON (MA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:BUBON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:LAWAI
Mailing Address - State:HI
Mailing Address - Zip Code:96765-0351
Mailing Address - Country:US
Mailing Address - Phone:808-332-5200
Mailing Address - Fax:
Practice Address - Street 1:4055 AKA RD
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756
Practice Address - Country:US
Practice Address - Phone:808-332-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT27101YM0800X
HIMFT #27101YM0800X
HIMFT# 27101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health