South, Domenica A

South, Domenica A is an individual health care provider with primary practice located at 50 Dayton Ln Andrus Children'S Center Mental Health Division, Peekskill NY 10566-2859. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. South, Domenica A can be contacted via phone (914) 736-3371.

Contact Information

Primary practice address
50 Dayton Ln Andrus Children'S Center Mental Health Division Peekskill NY 10566-2859
Phone: (914) 736-3371
Fax: (914) 736-3372
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X 067024 New York
Behavioral Health & Social Service Providers / Clinical 1041C0700X 076020 New York

Profile Details

NPI number 1407807837
LBN Legal business name South, Domenica A
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Nov 20th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407807837 NPPES
New York MEDICAID 00076020

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