Individual
DOMINIC J LIANTONIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
29 PINE ST, SOUTHBRIDGE, MA 01550-1823
(508) 764-9167
(508) 764-2462
Mailing address
29 PINE STREET, SOUTHBRIDGE, MA 01550
(508) 765-9167
(508) 764-2462
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5151
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1200704
—
MA
Enumeration date
01/09/2007
Last updated
11/20/2008
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