Provider Demographics
NPI:1619072881
Name:CARR, LINDA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:CARR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 C E. MANOA RD.
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822
Mailing Address - Country:US
Mailing Address - Phone:808-735-2228
Mailing Address - Fax:
Practice Address - Street 1:2961 C E. MANOA RD.
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-9682
Practice Address - Country:US
Practice Address - Phone:808-735-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05605504Medicaid
HI56085Medicare ID - Type UnspecifiedPSYCHOLOGIST