Provider Demographics
NPI:1477069714
Name:GRASSO, DOMINIQUE (BSW)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:GRASSO
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940
Mailing Address - Country:US
Mailing Address - Phone:978-728-1872
Mailing Address - Fax:
Practice Address - Street 1:62 BROWN ST STE 305
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6790
Practice Address - Country:US
Practice Address - Phone:978-521-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical