Provider Demographics
NPI:1760816342
Name:PRIMEAU, JOANNA (PHD,HSPP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:PRIMEAU
Suffix:
Gender:F
Credentials:PHD,HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BAYOU ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1034
Mailing Address - Country:US
Mailing Address - Phone:812-886-6800
Mailing Address - Fax:812-886-6809
Practice Address - Street 1:2007 STATE ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8505
Practice Address - Country:US
Practice Address - Phone:812-254-1558
Practice Address - Fax:812-254-8308
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042769A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201260700Medicaid