Individual
KRISTINE DOMINIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
4705 OLD POST RD, CHARLESTOWN, RI 02813-1819
(401) 364-7705
(401) 364-9104
Mailing address
PO BOX 899, CHARLESTOWN, RI 02813-0899
(401) 364-7705
(401) 364-9104
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01753
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
KD50510
—
RI
Enumeration date
12/14/2006
Last updated
07/08/2007
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