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NPI Code Detail

MEDICARE: DR. LISA OTTOMANELLI PH.D.

MEDICARE: DR. LISA OTTOMANELLI PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist25584TX

General Provider Information

NPI Number : 1922117159
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA OTTOMANELLI PH.D.
Provider Business Mailing Address
First Line : 2003 FAWNHOLLOW CT
Second Line :
City : ARLINGTON
State : TX
Zip : 76001-5662
Country : US
Telephone Number : 214-857-1768
Fax Number : 214-857-1759
Provider Business Practice Location Address
First Line : 4500 S LANCASTER RD
Second Line :
City : DALLAS
State : TX
Zip : 75216-7167
Country : US
Telephone Number : 214-857-1768
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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