Healthcare Provider Details

I. General information

NPI: 1568532968
Provider Name (Legal Business Name): CAROL SWANN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W KAAHUMANU AVE STE 202
KAHULUI HI
96732-1623
US

IV. Provider business mailing address

153 E KAMEHAMEHA AVE STE 104-248
KAHULUI HI
96732-3424
US

V. Phone/Fax

Practice location:
  • Phone: 866-855-2427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY1845
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1845
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY28594
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: