Healthcare Provider Details

I. General information

NPI: 1740847383
Provider Name (Legal Business Name): LILI DOMANICO MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 S YORK RD
HATBORO PA
19040-4036
US

IV. Provider business mailing address

649 S YORK RD
HATBORO PA
19040-4036
US

V. Phone/Fax

Practice location:
  • Phone: 215-543-4393
  • Fax:
Mailing address:
  • Phone: 215-543-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC015715
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: