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NPI Code Detail

MEDICARE: DOMINICK MASSENBERG SR.

MEDICARE: DOMINICK MASSENBERG SR.
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
1171M00000XCase Manager/Care CoordinatorDC
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1053012344
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINICK MASSENBERG SR.
Provider Business Mailing Address
First Line : 2549 ELVANS RD SE APT 404
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-3531
Country : US
Telephone Number : 202-843-7256
Fax Number :
Provider Business Practice Location Address
First Line : 1301 LENFANT SQ SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-6724
Country : US
Telephone Number : 202-269-2401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2023
Last Update Date : 12/02/2025

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Directions to “ DOMINICK MASSENBERG SR. ” Practice Location

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