=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730958430
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOMENICA TERINONI LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2023
-----------------------------------------------------
Last Update Date | 12/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4420 LIMESTONE RD STE 307
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-1956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-722-9717
-----------------------------------------------------
Fax | 302-224-1402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 547 ASHLAND RIDGE RD
-----------------------------------------------------
City | HOCKESSIN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19707-9662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | Q3-0011329
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------