Individual
MS. LISA ANN MAMMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS RPT
Contact information
Practice address
23 WOODLAND RD, MADISON, CT 06443
(203) 245-9293
(203) 245-2522
Mailing address
23 WOODLAND RD, MADISON, CT 06405
(203) 245-9293
(203) 245-2522
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
006580
CT
Other
Enumeration date
12/29/2006
Last updated
07/08/2007
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