MEDICARE: MS. DOMINIQUE LARAINE MCGRATH LAC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	37AC00924600	NJ

General Provider Information

NPI Number	:	1013863323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOMINIQUE LARAINE MCGRATH LAC, NCC

Provider Business Mailing Address
First Line	:	6 GARSIDE PL
Second Line	:
City	:	CLARK
State	:	NJ
Zip	:	07066-1715
Country	:	US
Telephone Number	:	908-721-6757
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 BEAVERSON BLVD STE 6A
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-7859
Country	:	US
Telephone Number	:	908-533-9808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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