Provider Demographics
NPI:1912166711
Name:LUNNON, CARRIE P (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:P
Last Name:LUNNON
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:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-0851
Mailing Address - Country:US
Mailing Address - Phone:808-375-3213
Mailing Address - Fax:
Practice Address - Street 1:145 LEHUA ST
Practice Address - Street 2:UNIT C
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2070
Practice Address - Country:US
Practice Address - Phone:808-375-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI550807Medicaid