Healthcare Provider Details

I. General information

NPI: 1902177355
Provider Name (Legal Business Name): LORI JEAN MANNONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 SW 89TH ST
OCALA FL
34476-9499
US

IV. Provider business mailing address

5660 SW 89TH ST
OCALA FL
34476-9499
US

V. Phone/Fax

Practice location:
  • Phone: 352-207-0075
  • Fax:
Mailing address:
  • Phone: 352-207-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberIMH8069
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH8069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: