=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710366554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL A PLUMMER PHD, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2015
-----------------------------------------------------
Last Update Date | 05/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 WAILUKU DR
-----------------------------------------------------
City | HILO
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96720-2488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-803-7702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 32
-----------------------------------------------------
City | OOKALA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96774-0032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-803-7702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3889
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------