Provider Demographics
NPI:1801941216
Name:DOMBROWSKI, VICTORIA LEIGH (RN, LMSW)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LEIGH
Last Name:DOMBROWSKI
Suffix:
Gender:F
Credentials:RN, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22509 AVON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:586-723-9585
Practice Address - Street 1:22509 AVON ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1481
Practice Address - Country:US
Practice Address - Phone:586-285-9909
Practice Address - Fax:586-723-9585
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010694981041C0700X
MI4704286320163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical