Eugene Domenico, PHD LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

034738-1 Issued in NY

Practice address

Market Street
Bewley Building Suite #437
Lockport, NY 14094

Phone

(716) 438-2436

Fax

(716) 438-2435

NPI assigned

Feb 23, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

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, 1985

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1679608103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MARKET STREET",
            "address_2": "BEWLEY BUILDING SUITE #437",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "14094",
            "telephone_number": "716-438-2436",
            "fax_number": "716-438-2435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MARKET STREET",
            "address_2": "BEWLEY BUILDING SUITE #437",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "14094",
            "telephone_number": "716-438-2436",
            "fax_number": "716-438-2435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMENICO",
        "first_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "PHD LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "034738-1",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "034738-1",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "034738-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00020255501",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000511600005",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Stuart Dick, D.D.S.
• Jarod Thomas Dickey
• Kayla Christine Dier
• Kristi Dierolf
• August James Domenico, DC
• Amanda Erin Domm, D.C.
• Margaret Donohue, PHD
• Susan L Donohue, RD, CDN
• Carolann Donorovich, RN
• Dr Juan de Rosas Physician PC

• Mental Health Counselor in Lockport, NY
• Providers in Lockport, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; 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.