Provider Demographics
NPI:1245206713
Name:PRIMEAU, MARGARET (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:PRIMEAU
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 1:2160 SO. FIRST AVENUE
Mailing Address - Street 2:FAHEY BLDG., ROOM 213
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-2220
Mailing Address - Fax:708-216-6840
Practice Address - Street 1:2160 SO. FIRST AVENUE
Practice Address - Street 2:FAHEY BLDG., ROOM 213
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-2220
Practice Address - Fax:708-216-6840
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71003501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL71003501Medicaid
R17788Medicare UPIN
IL565410Medicare ID - Type Unspecified