Provider Demographics
NPI:1811935422
Name:CARSTENS, LUCILLE (PHD)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:CARSTENS
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 1:197 NW 13TH CT
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3810
Mailing Address - Country:US
Mailing Address - Phone:360-675-9320
Mailing Address - Fax:
Practice Address - Street 1:75-5751 KUAKINI HWY
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1705
Practice Address - Country:US
Practice Address - Phone:808-329-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-190103TC0700X
WA1361103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1361OtherSTATE LICENSE
HIPSY-190OtherSTATE LICENSE
HIA237196Medicaid
HIR79193Medicare UPIN