Provider Demographics
NPI:1447483243
Name:DOMINICUS, SARA A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:A
Last Name:DOMINICUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 SHANNONS WAY
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-5270
Mailing Address - Country:US
Mailing Address - Phone:207-310-1230
Mailing Address - Fax:207-647-6015
Practice Address - Street 1:778 ROOSEVELT TRL STE 2B
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5376
Practice Address - Country:US
Practice Address - Phone:207-310-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC132651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical