MEDICARE: DR. SETH KUNEN PH.D., PSY.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	523	LA
2	103TP0016X	Prescribing (Medical) Psychologist	MP.000037	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MP.000037	OTHER	LA	MEDICAL PSYCHOLOGIST
3	523	OTHER	LA	CLINICAL PSYCHOLOGY LIC

General Provider Information

NPI Number	:	1073689378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH KUNEN PH.D., PSY.D.

Provider Business Mailing Address
First Line	:	12642 NEWCASTLE AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8982
Country	:	US
Telephone Number	:	225-802-0942
Fax Number	:	225-412-3830

Provider Business Practice Location Address
First Line	:	2435 DRUSILLA LN
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-1444
Country	:	US
Telephone Number	:	225-802-0942
Fax Number	:	225-412-3830

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	12/05/2016

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