Provider Demographics
NPI:1477719615
Name:MATTHEWS PAGE, DOMINA M (LSW)
Entity Type:Individual
Prefix:
First Name:DOMINA
Middle Name:M
Last Name:MATTHEWS PAGE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1433
Mailing Address - Country:US
Mailing Address - Phone:937-335-4543
Mailing Address - Fax:937-339-8371
Practice Address - Street 1:1059 N MARKET ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1433
Practice Address - Country:US
Practice Address - Phone:937-335-4543
Practice Address - Fax:937-339-8371
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0014706104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker