Provider Demographics
NPI:1376157537
Name:DOMINGUE, ARMINA (LMSW)
Entity Type:Individual
Prefix:
First Name:ARMINA
Middle Name:
Last Name:DOMINGUE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8643 PROVIDENT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1607
Mailing Address - Country:US
Mailing Address - Phone:672-667-7252
Mailing Address - Fax:
Practice Address - Street 1:775 MONTCLAIR DR
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-3652
Practice Address - Country:US
Practice Address - Phone:267-625-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-0000337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ3-0000337OtherPROFESSIONAL LICENSE