Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Theresa Rose Domenichello, LCSW

Individual provider Social Worker · NPI 1427646074

Theresa Rose Domenichello, LCSW is a Social Worker in Port Jeff Sta, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2021
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

See every abbreviation used in this directory →

Practice location Address checks out

646 Main St Ste 206
Port Jeff Sta, NY 11777-2230
Phone: (631) 213-9377
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence 106018 (NY)

Record details

NPI number1427646074
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorYes
NPI enumeratedJanuary 8, 2021
Last updated in NPPESOctober 21, 2024
Certification dateOctober 21, 2024

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