Provider Demographics
NPI:1063751410
Name:PRUNEAU, GENEVIEVE (PHD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:
Last Name:PRUNEAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 N WILLIAMS AVE STE F
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1468
Mailing Address - Country:US
Mailing Address - Phone:971-350-0900
Mailing Address - Fax:971-350-1490
Practice Address - Street 1:3808 N WILLIAMS AVE STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1468
Practice Address - Country:US
Practice Address - Phone:971-350-0900
Practice Address - Fax:971-350-1490
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical