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Individual
DR. EUGENE DOMENICO
Active
Individual
DR. EUGENE DOMENICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
034738-1
NY
103T00000X
Psychologist
034738-1
NY
1041C0700X
Clinical Social Worker
034738-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020255501
UNIVERA
NY
01
—
000511600005
BCBS
NY
Enumeration date
02/23/2007
Last updated
12/16/2009
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