Provider Demographics
NPI:1649614207
Name:LAMANCUSA, MICHELLE (CERTIFIED COUNSELOR)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LAMANCUSA
Suffix:
Gender:F
Credentials:CERTIFIED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 NE 96TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2350
Mailing Address - Country:US
Mailing Address - Phone:717-350-5229
Mailing Address - Fax:
Practice Address - Street 1:1822 NE 96TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2350
Practice Address - Country:US
Practice Address - Phone:717-350-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60760188103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst