Individual
MR. DOMINIC PATRICK PORUBSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2448 S 102ND ST STE 200, WEST ALLIS, WI 53227-2141
(414) 327-3000
Mailing address
18700 ANITA CT, BROOKFIELD, WI 53045-4229
(262) 765-1012
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041S0200X
School Social Worker
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/24/2022
Last updated
06/29/2022
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