MEDICARE: MR. THOMAS MARK DOMBROSKI 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	101YM0800X	Mental Health Counselor	3023C	NV

General Provider Information

NPI Number	:	1467669036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS MARK DOMBROSKI LCSW

Provider Business Mailing Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:	702-251-8000
Fax Number	:	702-366-0269

Provider Business Practice Location Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:	702-251-8000
Fax Number	:	702-366-0269

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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