Healthcare Provider Details

I. General information

NPI: 1427704519
Provider Name (Legal Business Name): DOMINIQUE MOSELLE REMINICK MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 MAIDEN LN
NEW YORK NY
10038-4812
US

IV. Provider business mailing address

1729 67TH ST APT A5
BROOKLYN NY
11204-4372
US

V. Phone/Fax

Practice location:
  • Phone: 212-780-2500
  • Fax:
Mailing address:
  • Phone: 908-666-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number027358
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: