Healthcare Provider Details

I. General information

NPI: 1255756656
Provider Name (Legal Business Name): JOHN LAMANNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2014
Last Update Date: 02/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 E MAIN ST
RAVENNA OH
44266-3136
US

IV. Provider business mailing address

2438 HESTON DR
LAKE MILTON OH
44429-9629
US

V. Phone/Fax

Practice location:
  • Phone: 330-947-2124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH3145204
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: