Provider Demographics
NPI:1801186036
Name:HEDGES-DOMENICUCCI, MARION (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:
Last Name:HEDGES-DOMENICUCCI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARION
Other - Middle Name:
Other - Last Name:HEDGES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3160 TELEGRAPH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3250
Mailing Address - Country:US
Mailing Address - Phone:805-642-4611
Mailing Address - Fax:805-585-3241
Practice Address - Street 1:3160 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3250
Practice Address - Country:US
Practice Address - Phone:805-642-4611
Practice Address - Fax:805-585-3241
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW297721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical