Provider Demographics
NPI:1568197465
Name:DUMOLA, LUCIANO SALEM
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:SALEM
Last Name:DUMOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2917
Mailing Address - Country:US
Mailing Address - Phone:631-772-3273
Mailing Address - Fax:
Practice Address - Street 1:1235 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2917
Practice Address - Country:US
Practice Address - Phone:631-772-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker