Provider Demographics
NPI:1447073499
Name:MASSENBERG, LUCQUERE
Entity type:Individual
Prefix:
First Name:LUCQUERE
Middle Name:
Last Name:MASSENBERG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1446
Mailing Address - Country:US
Mailing Address - Phone:313-500-9906
Mailing Address - Fax:
Practice Address - Street 1:3246 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1446
Practice Address - Country:US
Practice Address - Phone:313-500-9906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician