Provider Demographics
NPI:1043352453
Name:MAMON, LAKISHA YVETTE (MD)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:YVETTE
Last Name:MAMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:504-486-0023
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:504-486-0023
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0265722084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1063142Medicaid
LA3A969Medicare PIN
LA5CD42Medicare PIN
LA3A969CD42Medicare PIN
LA1063142Medicaid
LA5CY49Medicare PIN