Healthcare Provider Details

I. General information

NPI: 1073689378
Provider Name (Legal Business Name): SETH KUNEN PH.D., PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 DRUSILLA LN
BATON ROUGE LA
70809-1444
US

IV. Provider business mailing address

12642 NEWCASTLE AVE
BATON ROUGE LA
70816-8982
US

V. Phone/Fax

Practice location:
  • Phone: 225-802-0942
  • Fax: 225-412-3830
Mailing address:
  • Phone: 225-802-0942
  • Fax: 225-412-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number523
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.000037
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: