=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912166711
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE P LUNNON PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2008
-----------------------------------------------------
Last Update Date | 04/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 LEHUA ST UNIT C
-----------------------------------------------------
City | WAHIAWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96786-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-375-3213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 851
-----------------------------------------------------
City | HALEIWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96712-0851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-375-3213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY709
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------