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General NPI Number Information
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NPI Number | 1215358684
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Entity Type | Individual
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Provider Name | DOMINICK LOCIERO LMHC (LICENSE MENTAL
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Gender | Male
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 646 MAIN STREET
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-880-1370
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Fax |
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Provider Business Mailing Address
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Address Line | 192 CLUBHOUSE DRIVE
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City | PATCHOGUE
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State | NY
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Zip | 11772
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Country | US
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Telephone | 631-880-1370
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Fax | 631-474-4282
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002200-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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