Individual
MS. DOMINIQUE STASSART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW,LICSW
Contact information
Practice address
22 LEONARD AVE, #2, CAMBRIDGE, MA 02139-1020
(617) 784-8163
Mailing address
22 LEONARD AVE, #2, CAMBRIDGE, MA 02139-1020
(617) 784-8163
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
110629
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036030
NETWORK HEALTH
MA
05
—
1857673
—
MA
01
—
500567
VALUE OPTIONS
MA
01
—
P07813
BCBS
MA
Enumeration date
01/01/2007
Last updated
07/09/2007
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