Provider Demographics
NPI:1679278469
Name:TCHAMDJOU, LUCRECE MOMENI
Entity Type:Individual
Prefix:
First Name:LUCRECE
Middle Name:MOMENI
Last Name:TCHAMDJOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 OAK LEAF DR # C2018
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1311
Mailing Address - Country:US
Mailing Address - Phone:240-481-1751
Mailing Address - Fax:
Practice Address - Street 1:11225 OAK LEAF DR # C2018
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1311
Practice Address - Country:US
Practice Address - Phone:240-481-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator