Provider Demographics
NPI:1841696135
Name:DOMINIANNI, SHARI (LCSW)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:DOMINIANNI
Suffix:
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 1:9070 KIMBERLY BLVD 50
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2861
Mailing Address - Country:US
Mailing Address - Phone:561-852-0910
Mailing Address - Fax:561-852-0960
Practice Address - Street 1:10850 71ST AVE
Practice Address - Street 2:2G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4564
Practice Address - Country:US
Practice Address - Phone:561-531-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0812661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical