Provider Demographics
NPI:1699973172
Name:DOMBROSKI, KRISTIN ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANN
Last Name:DOMBROSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:ANN
Other - Last Name:ZEISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2502 POWELL AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1892
Mailing Address - Country:US
Mailing Address - Phone:814-833-1026
Mailing Address - Fax:814-833-1027
Practice Address - Street 1:2502 POWELL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1892
Practice Address - Country:US
Practice Address - Phone:814-833-1026
Practice Address - Fax:814-833-1027
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126033104100000X
PACW0163211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker