=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780721407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOMINGO MACEIRA LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 S BROADWAY FL 5
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-231-2935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 ROLLING MEADOW LN
-----------------------------------------------------
City | POUND RIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10576-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-995-5233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 040735
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------