Provider Demographics
NPI:1295231728
Name:DOMPKOWSKI MANN, STASIA
Entity Type:Individual
Prefix:
First Name:STASIA
Middle Name:
Last Name:DOMPKOWSKI MANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:DOMPKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 CURRAN RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-8002
Mailing Address - Country:US
Mailing Address - Phone:401-692-9390
Mailing Address - Fax:
Practice Address - Street 1:15 MARTIN ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-5361
Practice Address - Country:US
Practice Address - Phone:401-692-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00926101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health