| Doctor Name: | MARIA DOMITROVICH |
| NPI Number: | 1902143928 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6801094525 |
| Business Practice Address: | 401 10th Ave Menominee, MI - 498583009 |
| Business Phone Number: | 9067740522 |
| Business Fax Number: | |
| Mailing Address: | 715 Pyle Dr, KINGSFORD |
| State: | MI |
| Postal Code: | 498024456 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/10/2013 |
| NPI Last Update Date: | 01/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6801094525 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |