Provider Demographics
NPI:1952125718
Name:DOMICO, LINDSEY RENEA
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:RENEA
Last Name:DOMICO
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 1:930 COLEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3531
Mailing Address - Country:US
Mailing Address - Phone:304-365-5403
Mailing Address - Fax:
Practice Address - Street 1:930 COLEMAN AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3531
Practice Address - Country:US
Practice Address - Phone:304-365-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency