Provider Demographics
NPI:1639513484
Name:VALENCIA, BENNETT ZAKARIA (LCSW, BCBA)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:ZAKARIA
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-1065 EMEPELA WAY APT 1R
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3975
Mailing Address - Country:US
Mailing Address - Phone:808-265-3278
Mailing Address - Fax:
Practice Address - Street 1:615 PIIKOI ST STE 600
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3176
Practice Address - Country:US
Practice Address - Phone:808-265-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical