Provider Demographics
NPI:1780843359
Name:BARRIENTOS, GRACE MADARANG (LCSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MADARANG
Last Name:BARRIENTOS
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:PO BOX 4624
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-0624
Mailing Address - Country:US
Mailing Address - Phone:808-895-4850
Mailing Address - Fax:808-934-0071
Practice Address - Street 1:305 WAILUKU DR STE 5
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2488
Practice Address - Country:US
Practice Address - Phone:808-238-0270
Practice Address - Fax:808-443-0070
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-38881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI788359Medicaid