Provider Demographics
NPI:1841954534
Name:DOMINGUEZ, ROBERT (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 CHARTER CIR
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-6012
Mailing Address - Country:US
Mailing Address - Phone:347-234-6363
Mailing Address - Fax:
Practice Address - Street 1:41D EDGEWATER PARK
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3509
Practice Address - Country:US
Practice Address - Phone:914-663-7201
Practice Address - Fax:914-663-7203
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06223601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker