Provider Demographics
NPI:1710286844
Name:SMITH, PRISCILLA FUENTES (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:FUENTES
Last Name:SMITH
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 1:433A OLOMANA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2222
Mailing Address - Country:US
Mailing Address - Phone:808-554-4786
Mailing Address - Fax:
Practice Address - Street 1:BLDG 556 HEARD STREET
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857-5000
Practice Address - Country:US
Practice Address - Phone:808-655-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3694171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor