MEDICARE: DR. LYNN ALBERTSON PH.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	PSY-737	HI
2	103T00000X	Psychologist	PSY 16084	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY 16084	OTHER	CA	BOARD OF PSYCHOLOGY
2	PSY 737	OTHER	HI	BOARD OF PSYCHOLOGY

General Provider Information

NPI Number	:	1629096888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNN ALBERTSON PH.D.

Provider Business Mailing Address
First Line	:	1255 NUUANU AVE APT 2712
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-4014
Country	:	US
Telephone Number	:	503-703-4014
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 BISHOP ST
Second Line	:	#3005
City	:	HONOLULU
State	:	HI
Zip	:	96813-3301
Country	:	US
Telephone Number	:	503-703-4014
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/03/2016

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