Provider Demographics
NPI:1649551540
Name:MASSARO, LUSANNE YVETTE
Entity type:Individual
Prefix:
First Name:LUSANNE
Middle Name:YVETTE
Last Name:MASSARO
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 1:2626 75TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1427
Mailing Address - Country:US
Mailing Address - Phone:718-350-3143
Mailing Address - Fax:
Practice Address - Street 1:2626 75TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1427
Practice Address - Country:US
Practice Address - Phone:718-350-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health