MEDICARE: YASMINE DOMINIQUE-MERVEUS MSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1053713016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASMINE DOMINIQUE-MERVEUS MSW

Provider Business Mailing Address
First Line	:	1 SOUTH BLVD E # 3232
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-7547
Country	:	US
Telephone Number	:	863-866-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SOUTH BLVD E # 3232
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-7547
Country	:	US
Telephone Number	:	863-866-0909
Fax Number	:

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

Provider Enumeration Date	:	09/22/2014
Last Update Date	:	07/08/2021

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