Provider Demographics
NPI:1063551505
Name:LAMANNA, LISA (RLCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LAMANNA
Suffix:
Gender:F
Credentials:RLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W JERICHO TPKE STE 203E
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3220
Mailing Address - Country:US
Mailing Address - Phone:631-806-2080
Mailing Address - Fax:
Practice Address - Street 1:811 W JERICHO TPKE STE 203E
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3220
Practice Address - Country:US
Practice Address - Phone:631-806-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NYR054874-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000214473OtherUNITED BEHAVIORAL HEALTH
NY549242OtherVALUE OPTIONS
NYR054874-01OtherNEW YORK STATE EDUCATION DEPARTMENT