Provider Demographics
NPI:1245676147
Name:NICOLAS-ENGLAND, DOMINIQUE MARIE
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:MARIE
Last Name:NICOLAS-ENGLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DOMINIQUE
Other - Middle Name:MARIE
Other - Last Name:NICOLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:11154 146TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5802
Mailing Address - Country:US
Mailing Address - Phone:718-641-2694
Mailing Address - Fax:
Practice Address - Street 1:11154 146TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5802
Practice Address - Country:US
Practice Address - Phone:718-641-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0475181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical