Provider Demographics
NPI:1750912838
Name:DEDOMINICIS, ALBERT A III (MS,LBS)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:A
Last Name:DEDOMINICIS
Suffix:III
Gender:M
Credentials:MS,LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:15042-1805
Mailing Address - Country:US
Mailing Address - Phone:412-260-6649
Mailing Address - Fax:
Practice Address - Street 1:1607 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2420
Practice Address - Country:US
Practice Address - Phone:724-728-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health