Provider Demographics
NPI:1477908317
Name:LAMANNA, MARTIA (RBT)
Entity Type:Individual
Prefix:
First Name:MARTIA
Middle Name:
Last Name:LAMANNA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 COMET ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-2626
Mailing Address - Country:US
Mailing Address - Phone:203-819-3959
Mailing Address - Fax:
Practice Address - Street 1:8309 COMET ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-2626
Practice Address - Country:US
Practice Address - Phone:203-819-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-16-24630106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician