Provider Demographics
NPI:1659397305
Name:LAMANNA, LAUREN C (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:C
Last Name:LAMANNA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:G
Other - Last Name:CANESTRARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:115 MILL ST
Mailing Address - Street 2:MAIL STOP 128
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1064
Mailing Address - Country:US
Mailing Address - Phone:617-855-2887
Mailing Address - Fax:
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1064
Practice Address - Country:US
Practice Address - Phone:617-855-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00118-P235Z00000X
MA8058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2092OtherEI NHPRC
MA1201175Medicaid
RI4600103OtherEI UHP
RI412296OtherEI BCHIP
MA030769OtherBC/BS
RI292177OtherEI BCROSS
RI412296OtherEI BCHIP