Provider Demographics
NPI:1366893497
Name:RAUSSEO, JOANNA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:RAUSSEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13829 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-4502
Mailing Address - Country:US
Mailing Address - Phone:727-301-8203
Mailing Address - Fax:
Practice Address - Street 1:13829 KIMBERLY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-4502
Practice Address - Country:US
Practice Address - Phone:727-301-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
73-1703319OtherPRIVATE INSURANCE