Doctor Name: | RICHARD GIRARD-DOMENA |
NPI Number: | 1326369257 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 115618 |
Business Practice Address: | 2835 Middle Country Rd Lake Grove, NY - 117552105 |
Business Phone Number: | 5163189545 |
Business Fax Number: | |
Mailing Address: | P.o. Box 150, CENTEREACH |
State: | NY |
Postal Code: | 11720 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/15/2010 |
NPI Last Update Date: | 01/31/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 115618 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |