Active NPI
Peter Dedominici, LSW
- Mental Health Counselor
- Fairborn, OH
National Provider Identifier
1649923442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 188 W Hebble Ave
Fairborn, OH 45324-4960 - Phone
- (937) 754-5911
- Fax
- (999) 999-9999
- NPI assigned
- Feb 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S0029122 | OH | |
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
188 W Hebble Ave
Fairborn, OH 45324-4960
Mailing address
PO Box 3095
Dublin, OH 43016-0046
Phone (937) 754-5911
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pDeDominici@projectcureinc.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S0029122 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677024000000",
"number": "1649923442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3095",
"city": "DUBLIN",
"state": "OH",
"postal_code": "430160046",
"telephone_number": "937-754-5911",
"fax_number": "999-999-9999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "188 W HEBBLE AVE",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453244960",
"telephone_number": "937-754-5911",
"fax_number": "999-999-9999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDOMINICI",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-01",
"last_updated": "2023-02-22",
"certification_date": "2023-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S0029122",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pDeDominici@projectcureinc.org",
"affiliation": "N",
"endpointDescription": "email address",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "200 Daruma Pkwy",
"city": "Moraine",
"state": "OH",
"country_code": "US",
"postal_code": "454397909",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.