MEDICARE: LYNETTE LABASAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY759	HI

General Provider Information

NPI Number	:	1588608277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE LABASAN PH.D.

Provider Business Mailing Address
First Line	:	1600 KAPIOLANI BLVD
Second Line	:	SUITE 1306
City	:	HONOLULU
State	:	HI
Zip	:	96814-3801
Country	:	US
Telephone Number	:	808-949-7444
Fax Number	:	808-949-6262

Provider Business Practice Location Address
First Line	:	1600 KAPIOLANI BLVD
Second Line	:	SUITE 1306
City	:	HONOLULU
State	:	HI
Zip	:	96814-3801
Country	:	US
Telephone Number	:	808-949-7444
Fax Number	:	808-949-6262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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