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NPI Code Detail

MEDICARE: LUSANNE YVETTE MASSARO

MEDICARE: LUSANNE YVETTE MASSARO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1649551540
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUSANNE YVETTE MASSARO
Provider Business Mailing Address
First Line : 2626 75TH ST
Second Line :
City : EAST ELMHURST
State : NY
Zip : 11370-1427
Country : US
Telephone Number : 718-350-3143
Fax Number :
Provider Business Practice Location Address
First Line : 2626 75TH ST
Second Line :
City : EAST ELMHURST
State : NY
Zip : 11370-1427
Country : US
Telephone Number : 718-350-3143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2011
Last Update Date : 09/06/2011

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Directions to “ LUSANNE YVETTE MASSARO ” Practice Location

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