Provider Demographics
NPI:1831963750
Name:ZIENKIEWICZ, DOMINIKA (LPCZ)
Entity type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:
Last Name:ZIENKIEWICZ
Suffix:
Gender:F
Credentials:LPCZ
Other - Prefix:
Other - First Name:DOMINIKA
Other - Middle Name:
Other - Last Name:STASZKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCZ
Mailing Address - Street 1:61 BENTWOOD DR APT 9
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3615
Mailing Address - Country:US
Mailing Address - Phone:475-202-2602
Mailing Address - Fax:
Practice Address - Street 1:61 BENTWOOD DR APT 9
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3615
Practice Address - Country:US
Practice Address - Phone:475-202-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health