MEDICARE: MARGARET CHANDRIKALA DOMAN X LCSW

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	1041C0700X	Clinical Social Worker	SW7351	FL

General Provider Information

NPI Number	:	1386778454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET CHANDRIKALA DOMAN X LCSW

Provider Business Mailing Address
First Line	:	200 S INDIAN RIVER DR STE 309
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4332
Country	:	US
Telephone Number	:	772-708-4271
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S INDIAN RIVER DR STE 309
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4332
Country	:	US
Telephone Number	:	772-708-4271
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/09/2007

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