Provider Demographics
NPI:1023137288
Name:DOHMEN, ELAINE MARIE
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:DOHMEN
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 1:4630 SE SUMMERLAND PL
Mailing Address - Street 2:APT 4
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8399
Mailing Address - Country:US
Mailing Address - Phone:772-221-8585
Mailing Address - Fax:772-221-8371
Practice Address - Street 1:2814 S US HIGHWAY 1
Practice Address - Street 2:SUITE D4
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8120
Practice Address - Country:US
Practice Address - Phone:772-221-8585
Practice Address - Fax:772-221-8371
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical