Active NPI
Rebecca Rose Dominguez, LMSW
- Clinical Social Worker
- Freeport, NY
National Provider Identifier
1962037341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 108756-01
- Practice address
- 91 Guy Lombardo Ave
Freeport, NY 11520-3731 - Phone
- (516) 868-3030
- NPI assigned
- Mar 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 108756-01 | NY | Primary |
| School Social Worker | 1041S0200X | 108756-01 | NY | |
| School Social Worker | 1041S0200X |
Addresses
Primary practice location
91 Guy Lombardo Ave
Freeport, NY 11520-3731
Mailing address
122 Park Ave
Williston Park, NY 11596-1630
Phone (516) 941-8204
Other practice location 1
187-30 Grand Central Pkwy
Jamaica, NY 11432-5819
Phone (516) 941-8204
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Jamaica |
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 |
|---|---|---|---|
| 108756-01 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598486400000",
"number": "1962037341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 PARK AVE",
"city": "WILLISTON PARK",
"state": "NY",
"postal_code": "115961630",
"telephone_number": "516-941-8204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91 GUY LOMBARDO AVE",
"city": "FREEPORT",
"state": "NY",
"postal_code": "115203731",
"telephone_number": "516-868-3030"
}
],
"practiceLocations": [
{
"address_1": "187-30 Grand Central Pkwy",
"address_purpose": "LOCATION",
"city": "Jamaica",
"state": "NY",
"postal_code": "114325819",
"country_code": "US",
"telephone_number": "516-941-8204",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "REBECCA",
"middle_name": "ROSE",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-06",
"last_updated": "2020-08-27",
"certification_date": "2020-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "108756-01",
"primary": true
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "NY",
"license": "108756-01",
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Jamaica",
"affiliation": "N",
"address_1": "18730 Grand Central Pkwy",
"city": "Jamaica",
"state": "NY",
"country_code": "US",
"postal_code": "114325819",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Freeport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.