Provider Demographics
NPI:1033465497
Name:LMAMON MD, LLC
Entity Type:Organization
Organization Name:LMAMON MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-723-3132
Mailing Address - Street 1:3909 BIENVILLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5151
Mailing Address - Country:US
Mailing Address - Phone:504-486-0020
Mailing Address - Fax:
Practice Address - Street 1:3909 BIENVILLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5151
Practice Address - Country:US
Practice Address - Phone:504-486-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0265722084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty