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General NPI Number Information
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NPI Number | 1003597592
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Entity Type | Individual
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Provider Name | DOMINIQUA SHEKEVIA BERNARDIN LISW
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Gender | Female
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 10200 ALLIANCE RD STE 150
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City | BLUE ASH
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State | OH
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Zip | 45242-4754
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Country | US
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Telephone | 513-891-0650
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Fax |
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Provider Business Mailing Address
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Address Line | 6136 S JEFFERSON ST
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City | BURLINGTON
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State | KY
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Zip | 41005-9689
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Country | US
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Telephone | 786-424-0632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 258052
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2405570
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License Number State | OH
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