Provider Demographics
NPI:1053713016
Name:DOMINIQUE-MERVEUS, YASMINE (MSW)
Entity type:Individual
Prefix:
First Name:YASMINE
Middle Name:
Last Name:DOMINIQUE-MERVEUS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:YASMINE
Other - Middle Name:
Other - Last Name:DOMINIQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1 SOUTH BLVD E # 3232
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7547
Mailing Address - Country:US
Mailing Address - Phone:863-866-0909
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH BLVD E # 3232
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7547
Practice Address - Country:US
Practice Address - Phone:863-866-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator