Individual
DR. DOMENICK TIRABASSI IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8492
(920) 926-8903
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8492
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5089-57
WI
Other
Enumeration date
07/24/2019
Last updated
08/31/2024
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