Provider Demographics
NPI:1790201945
Name:DOMOND, GIRLAINE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:GIRLAINE
Middle Name:
Last Name:DOMOND
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 1:13018 231ST ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1832
Mailing Address - Country:US
Mailing Address - Phone:718-809-0710
Mailing Address - Fax:
Practice Address - Street 1:13018 231ST ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-1832
Practice Address - Country:US
Practice Address - Phone:718-809-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071278-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty