Individual
MR. DOMINIC MICHAEL BASTINELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSCSW
Contact information
Practice address
4101 S 4TH ST, BLDG 160, LEAVENWORTH, KS 66048-5014
(913) 682-2000
(913) 758-4149
Mailing address
4101 S 4TH ST, BLDG 160, LEAVENWORTH, KS 66048-5014
(913) 682-2000
(913) 758-4149
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4504
KS
Other
Enumeration date
04/22/2013
Last updated
03/14/2017
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