Provider Demographics
NPI:1992685044
Name:LAMANTIA, MEGAN ROSE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:LAMANTIA
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 1:4600 E WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1908
Mailing Address - Country:US
Mailing Address - Phone:512-206-0190
Mailing Address - Fax:516-926-0190
Practice Address - Street 1:4600 E WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1908
Practice Address - Country:US
Practice Address - Phone:512-206-0190
Practice Address - Fax:516-926-0190
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician