Provider Demographics
NPI:1972656866
Name:LEMIEUX, ANITA PRASAD (LICSW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:PRASAD
Last Name:LEMIEUX
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9431 COPPERTOP LOOP NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3684
Mailing Address - Country:US
Mailing Address - Phone:206-552-1431
Mailing Address - Fax:
Practice Address - Street 1:9431 COPPERTOP LOOP NE
Practice Address - Street 2:SUITE B
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3684
Practice Address - Country:US
Practice Address - Phone:206-552-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1128354Medicaid