Individual
LISA LAMANCUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
5005 PLAINFIELD AVE NE STE 100, GRAND RAPIDS, MI 49525-9747
(616) 279-3869
(616) 608-4657
Mailing address
5005 PLAINFIELD AVE NE STE 100, GRAND RAPIDS, MI 49525-9747
(616) 279-3869
(616) 608-4657
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301012462
MI
Other
Enumeration date
12/14/2013
Last updated
04/28/2020
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