Provider Demographics
NPI:1912146184
Name:DOMBROWSKI, ELAINE ELLEN (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ELLEN
Last Name:DOMBROWSKI
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 W MAIN RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2046
Mailing Address - Country:US
Mailing Address - Phone:440-228-0506
Mailing Address - Fax:
Practice Address - Street 1:384 W MAIN RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2046
Practice Address - Country:US
Practice Address - Phone:440-228-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 00102491041C0700X
OHS.0010249261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)