Provider Demographics
NPI:1609180884
Name:DOMINIQUE-MCLAIN, MARGARET (LMSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:DOMINIQUE-MCLAIN
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 1:88 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-3811
Mailing Address - Country:US
Mailing Address - Phone:631-399-5833
Mailing Address - Fax:
Practice Address - Street 1:88 MADISON ST
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-3811
Practice Address - Country:US
Practice Address - Phone:631-399-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0748571041S0200X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074857OtherLMSW