Provider Demographics
NPI:1326369257
Name:GIRARD-DOMENA, RICHARD (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GIRARD-DOMENA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-0177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 EAST FIFTH STREET
Practice Address - Street 2:15TH FLOOR PMB #744
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202
Practice Address - Country:US
Practice Address - Phone:513-952-9595
Practice Address - Fax:631-337-7846
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2102567-SUPV1041C0700X
MA1156181041C0700X
NY0789411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty