Provider Demographics
NPI:1912027400
Name:DOMINIK, CLAUDIA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:M
Last Name:DOMINIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1531 13TH ST
Mailing Address - Street 2:STE 2520
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1312
Mailing Address - Country:US
Mailing Address - Phone:812-376-6501
Mailing Address - Fax:812-376-6551
Practice Address - Street 1:1531 13TH ST
Practice Address - Street 2:STE 2520
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1312
Practice Address - Country:US
Practice Address - Phone:812-376-6501
Practice Address - Fax:812-376-6551
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004903A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical