Provider Demographics
NPI:1568128643
Name:DOMINIQUE, CARMEN (LMSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:DOMINIQUE
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 1:2446 PRESSBURG ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-5450
Mailing Address - Country:US
Mailing Address - Phone:504-261-7310
Mailing Address - Fax:
Practice Address - Street 1:2446 PRESSBURG ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-5450
Practice Address - Country:US
Practice Address - Phone:504-261-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker