Provider Demographics
NPI:1881776953
Name:JOANN LEMAISTRE, PH.D. A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:JOANN LEMAISTRE, PH.D. A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-255-9279
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:701-255-9729
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5758103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY5758OtherSTATE LIC
CA00PL57580Medicare ID - Type Unspecified