Provider Demographics
NPI:1073689378
Name:KUNEN, SETH (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:KUNEN
Suffix:
Gender:M
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12642 NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8982
Mailing Address - Country:US
Mailing Address - Phone:225-802-0942
Mailing Address - Fax:225-412-3830
Practice Address - Street 1:2435 DRUSILLA LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1444
Practice Address - Country:US
Practice Address - Phone:225-802-0942
Practice Address - Fax:225-412-3830
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA523103TC0700X
LAMP.000037103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136948Medicaid
LAMP.000037OtherMEDICAL PSYCHOLOGIST
LA523OtherCLINICAL PSYCHOLOGY LIC
LA1136948Medicaid