Healthcare Provider Details

I. General information

NPI: 1093995177
Provider Name (Legal Business Name): JOSEPH ANTHONY LAMANNA D.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

2495 SHREVEPORT HWY
PINEVILLE LA
71360-4044
US

V. Phone/Fax

Practice location:
  • Phone: 318-466-4185
  • Fax:
Mailing address:
  • Phone: 318-466-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number991
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number991
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number991
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number991
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number991
License Number StateLA
# 6
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number991
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: