Healthcare Provider Details

I. General information

NPI: 1881776953
Provider Name (Legal Business Name): JOANN LEMAISTRE, PH.D. A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 HAMILTON AVE SUITE 9
PALO ALTO CA
94301-1830
US

IV. Provider business mailing address

177 BOVET RD FL 6 ATTN: CD BILLING
SAN MATEO CA
94402-3116
US

V. Phone/Fax

Practice location:
  • Phone: 650-321-5454
  • Fax: 650-321-5492
Mailing address:
  • Phone: 701-255-9729
  • Fax: 701-222-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5758
License Number StateCA

VIII. Authorized Official

Name: MRS. JOANN LEMAISTRE
Title or Position: PSYCHOLOGY
Credential: PH.D
Phone: 701-255-9279