Jessica Catherine Dominguez, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

082105 Issued in NY

Practice address

11 Route 111
Smithtown, NY 11787-3712

Phone

(631) 920-8300

Fax

(631) 920-8460

NPI assigned

Jun 3, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2009

Medicare assignment

May accept Medicare assignment

Group practices

Welllife Network IncGroup PAC ID 0749179570, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Welllife Network Inc.,

  • Clinic/Center
  • Huntington, NY
  • NPI 1932125721
  Medicare reassignment Care Compare group NPD
• Welllife Network Inc

  • Case Management Agency
  • Elmont, NY
  • NPI 1508012816
  NPD
• Welllife Network Inc.

  • Case Management Agency
  • Coram, NY
  • NPI 1386817906
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440028800000",
    "number": "1407176209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 ROUTE 111",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873712",
            "telephone_number": "631-920-8300",
            "fax_number": "631-920-8460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 ROUTE 111",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873712",
            "telephone_number": "631-920-8300",
            "fax_number": "631-920-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "JESSICA",
        "middle_name": "CATHERINE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-03",
        "last_updated": "2015-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "080537-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "082105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynda Elyzabeth Doherty, MSED
• Jennifer I. Dolan, PT
• Judy A Dolce, LPN
• Kevin Dolley, N.P.
• Jennifer Dominguez Umana
• Jesse Donaldson-Hawkins
• Debra J Donaldson, L.C.S.W.
• Daniel Donato, P.T.
• Patricia A Donato, COTA
• Robert Daniel Dondiego, O.D.

• Clinical Social Worker in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.