Healthcare Provider Details

I. General information

NPI: 1033465497
Provider Name (Legal Business Name): LMAMON MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 BIENVILLE ST SUITE 102
NEW ORLEANS LA
70119-5151
US

IV. Provider business mailing address

3909 BIENVILLE ST SUITE 102
NEW ORLEANS LA
70119-5151
US

V. Phone/Fax

Practice location:
  • Phone: 504-486-0020
  • Fax:
Mailing address:
  • Phone: 504-486-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number026572
License Number StateLA

VIII. Authorized Official

Name: DR. LAKISHA MAMON
Title or Position: PHYSICIAN/MANAGER
Credential: MD
Phone: 504-723-3132