Provider Demographics
NPI:1528572179
Name:DOMALEWICZ, JESSICA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DOMALEWICZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:IAGROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2008
Mailing Address - Country:US
Mailing Address - Phone:518-381-8911
Mailing Address - Fax:
Practice Address - Street 1:530 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305
Practice Address - Country:US
Practice Address - Phone:518-381-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-18
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098767-1101YM0800X
NY098767104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health