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NPI Code Detail

MEDICARE: NICOLE DOMINICK MA LLP

MEDICARE: NICOLE DOMINICK MA LLP
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
1103T00000XPsychologist6301011786MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1750910681OTHERMIBLUE CROSS

General Provider Information

NPI Number : 1285873224
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE DOMINICK MA LLP
Provider Business Mailing Address
First Line : 42669 GARFIELD RD
Second Line :
City : CLINTON TWP
State : MI
Zip : 48038-5036
Country : US
Telephone Number : 586-412-5321
Fax Number :
Provider Business Practice Location Address
First Line : 29750 HARPER AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-2607
Country : US
Telephone Number : 586-777-3200
Fax Number : 586-777-7855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2009
Last Update Date : 09/12/2025

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Directions to “ NICOLE DOMINICK MA LLP” Practice Location

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