Healthcare Provider Details

I. General information

NPI: 1548170772
Provider Name (Legal Business Name): DOMANICK ARNOLD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 107
LARGO MD
20774-3711
US

IV. Provider business mailing address

9500 MEDICAL CENTER DR STE 107
LARGO MD
20774-3711
US

V. Phone/Fax

Practice location:
  • Phone: 240-539-2940
  • Fax:
Mailing address:
  • Phone: 240-539-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35391
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: