Provider Demographics
NPI:1306865126
Name:LEMAISTRE, JOANN (PHD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:LEMAISTRE
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 1:177 BOVET RD FL 6
Mailing Address - Street 2:ATTN: CD BILLING
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3116
Mailing Address - Country:US
Mailing Address - Phone:701-255-9279
Mailing Address - Fax:701-222-4142
Practice Address - Street 1:467 HAMILTON AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1830
Practice Address - Country:US
Practice Address - Phone:650-321-5454
Practice Address - Fax:650-321-5492
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5758103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL57580Medicare ID - Type Unspecified