Provider Demographics
NPI:1184752503
Name:GIANDOMENICO, DONNA MARIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:GIANDOMENICO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2406
Mailing Address - Country:US
Mailing Address - Phone:518-569-1051
Mailing Address - Fax:518-561-2980
Practice Address - Street 1:109 W BAY PLZ
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1785
Practice Address - Country:US
Practice Address - Phone:518-561-1316
Practice Address - Fax:518-561-2980
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000451-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health