Provider Demographics
NPI:1982249660
Name:LAMANNA, MELISSA CELESTE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CELESTE
Last Name:LAMANNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 RIVERSIDE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4658
Mailing Address - Country:US
Mailing Address - Phone:904-472-0017
Mailing Address - Fax:
Practice Address - Street 1:2247 RIVERSIDE AVE APT 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4658
Practice Address - Country:US
Practice Address - Phone:904-472-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health