Provider Demographics
NPI:1932763315
Name:VANWAUS-CARREON, LYNNETTE DAWN (RBT)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:DAWN
Last Name:VANWAUS-CARREON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4839
Mailing Address - Country:US
Mailing Address - Phone:760-213-6966
Mailing Address - Fax:
Practice Address - Street 1:1869 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4839
Practice Address - Country:US
Practice Address - Phone:760-213-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19-85059106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician