Provider Demographics
NPI:1962541557
Name:CARLSON, BOBBI (PSYD)
Entity type:Individual
Prefix:DR
First Name:BOBBI
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PSYD
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 394
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-0394
Mailing Address - Country:US
Mailing Address - Phone:808-484-5995
Mailing Address - Fax:808-484-5995
Practice Address - Street 1:98-084 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 304
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5122
Practice Address - Country:US
Practice Address - Phone:808-484-5995
Practice Address - Fax:808-484-5995
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 551103TC0700X
HIPSY551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002091-01Medicaid
HI517475Medicare UPIN
HI002091-01Medicaid