=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376157537
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARMINA DOMINGUE LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2020
-----------------------------------------------------
Last Update Date | 09/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 775 MONTCLAIR DR
-----------------------------------------------------
City | CLAYMONT
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19703-3652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-625-2343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8643 PROVIDENT ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19150-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 672-667-7252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | Q3-0000337
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------