Provider Demographics
NPI:1386778454
Name:DOMAN, MARGARET CHANDRIKALA X (LCSW)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:CHANDRIKALA
Last Name:DOMAN
Suffix:X
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S INDIAN RIVER DR STE 309
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4332
Mailing Address - Country:US
Mailing Address - Phone:772-708-4271
Mailing Address - Fax:
Practice Address - Street 1:200 S INDIAN RIVER DR STE 309
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4332
Practice Address - Country:US
Practice Address - Phone:772-708-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW73511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical