| Doctor Name: | PROF. MERYL GREER DOMINA |
| NPI Number: | 1023394202 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW, PH.D. |
| License Number: | 150-003461 |
| Business Practice Address: | 14 Health Services Drive Dekalb, IL - 60115 |
| Business Phone Number: | 8157588616 |
| Business Fax Number: | 8157587569 |
| Mailing Address: | 1121 Loren Dr, DEKALB |
| State: | IL |
| Postal Code: | 601152102 |
| Phone Number: | 8157584827 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2011 |
| NPI Last Update Date: | 11/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 150-003461 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |