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NPI Code Detail

MEDICARE: TERRY DOMINO CSW, MLA

MEDICARE: TERRY DOMINO CSW, MLA
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
1104100000XSocial Worker13761LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113761OTHERLACSW

General Provider Information

NPI Number : 1598283087
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY DOMINO CSW, MLA
Provider Business Mailing Address
First Line : 4300 S I 10 SERVICE RD W STE 215
Second Line :
City : METAIRIE
State : LA
Zip : 70001-7436
Country : US
Telephone Number : 504-301-9990
Fax Number :
Provider Business Practice Location Address
First Line : 4300 S I 10 SERVICE RD W STE 215
Second Line :
City : METAIRIE
State : LA
Zip : 70001-7436
Country : US
Telephone Number : 504-301-9990
Fax Number : 504-301-9990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2017
Last Update Date : 09/05/2017

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Directions to “ TERRY DOMINO CSW, MLA” Practice Location

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