Provider Demographics
NPI:1720394018
Name:PRIMEAU, SARA BRANSON (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BRANSON
Last Name:PRIMEAU
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 1:1232 CATULA AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-1922
Mailing Address - Country:US
Mailing Address - Phone:765-409-6274
Mailing Address - Fax:
Practice Address - Street 1:133 N 4TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1371
Practice Address - Country:US
Practice Address - Phone:765-409-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001838A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical