Doctor Name: | MRS. REBECCA LENORE DOMROE |
NPI Number: | 1861440588 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | R028514-1 |
Business Practice Address: | 4576 Waterhouse Rd Clay, NY - 130419613 |
Business Phone Number: | 3156526338 |
Business Fax Number: | 3156526338 |
Mailing Address: | 4576 Waterhouse Rd, CLAY |
State: | NY |
Postal Code: | 130419613 |
Phone Number: | 3156526338 |
Fax Number: | 3156526338 |
NPI Enumeration Date: | 05/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | R028514-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |