Provider Demographics
NPI:1730397829
Name:WRIGHT, LYNDA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
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 1274
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-1274
Mailing Address - Country:US
Mailing Address - Phone:808-430-3176
Mailing Address - Fax:
Practice Address - Street 1:2200 MAIN STREET
Practice Address - Street 2:SUITE 505
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1624
Practice Address - Country:US
Practice Address - Phone:808-430-3176
Practice Address - Fax:808-878-2970
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI30801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI249963Medicaid
HIAQ866ZMedicare PIN