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General NPI Number Information
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NPI Number | 1699973172
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Entity Type | Individual
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Provider Name | KRISTIN ANN DOMBROSKI LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 2502 POWELL AVE SUITE 6
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City | ERIE
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State | PA
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Zip | 16506-1892
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Country | US
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Telephone | 814-833-1026
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Fax | 814-833-1027
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Provider Business Mailing Address
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Address Line | 2502 POWELL AVE SUITE 6
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City | ERIE
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State | PA
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Zip | 16506-1892
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Country | US
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Telephone | 814-833-1026
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Fax | 814-833-1027
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW126033
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License Number State | PA
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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 | CW016321
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License Number State | PA
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