Provider Demographics
NPI:1689076739
Name:CHIASSON, CARMENNE ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:CARMENNE
Middle Name:ANNE
Last Name:CHIASSON
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 1:389 KAIMAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2018
Mailing Address - Country:US
Mailing Address - Phone:808-589-9158
Mailing Address - Fax:808-596-8558
Practice Address - Street 1:389 KAIMAKE LOOP
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2018
Practice Address - Country:US
Practice Address - Phone:808-589-9158
Practice Address - Fax:808-596-8558
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-645103TA0700X, 103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities