| Doctor Name: | MARK DOMINIQUE |
| NPI Number: | 1831423201 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARM.D, LCSW |
| License Number: | LC12200 |
| Business Practice Address: | 65 Western Ave Rite Aid Hampden, ME - 044441423 |
| Business Phone Number: | 2078624900 |
| Business Fax Number: | |
| Mailing Address: | 65 Western Ave, HAMPDEN |
| State: | ME |
| Postal Code: | 044441423 |
| Phone Number: | 2078624900 |
| Fax Number: | |
| NPI Enumeration Date: | 10/01/2009 |
| NPI Last Update Date: | 07/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LC12200 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |