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MRS. MARY ELIZABETH DOMINO LCSW-C
NPI 1760666424
Social Worker - Clinical in Centreville, MD

Active since December 18, 2007PECOS EnrolledAccepts Medicare Assignment
120 BANJO LANE, CENTREVILLE, MD 21617(410) 758-3050(410) 758-0698 Get Directions Write a Review

NPPES record last updated: October 4, 2023. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Oct 4, 2023, Jul 21, 2022, Jun 30, 2017 (3 updates tracked since 2017).

About Mrs. Mary Elizabeth Domino Lcsw-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. MARY ELIZABETH DOMINO LCSW-C (NPI 1760666424) is an individual clinical provider in Centreville, Maryland, licensed in Maryland (10791) and active in the NPI registry since December 2007. She is enrolled in Medicare PECOS and is a graduate of Other (1991).

NPPES Registry Identity

NPI1760666424
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameMRS. MARY ELIZABETH DOMINOCredential: LCSW-C
Location Address120 BANJO LANECentreville, MD 21617
Mailing Address120 Banjo Ln.Centreville, MD 21617 · (410) 758-2211 · Fax (410) 758-0698
Phone(410) 758-3050
Fax(410) 758-0698
Sole ProprietorNo
Medical School CMSOtherGraduated 1991
Enumeration DateDecember 18, 2007
Last NPPES UpdateOctober 4, 20233 updates tracked since enumeration
NPPES CertifiedOctober 4, 2023
✔ NPI 1760666424 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in MD · 10791
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
120 BANJO LANE, Centreville, MD 21617
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Other Names 1

Former Name (1)Mrs. Mary Elizabeth Hall Lcsw-c

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Mary Elizabeth Domino Lcsw-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4183619513
PECOS Enrollment IDI20080424000545
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Psychotherapy, 30 minutes 90832
Psychotherapy is a therapeutic interaction or treatment between a trained professional and a patient. In a 30-minute session, the therapist helps you explore feelings, thoughts, and behaviors to better understand yourself and manage life's challenges.
171 services37 patients
Psychotherapy, 45 minutes 90834
Psychotherapy is a treatment method where you converse with a therapist about your thoughts, feelings, and behaviors. In a 45-minute session, the therapist assists you in understanding and managing your mental health concerns, improving emotional wellness, and promoting personal growth.
164 services38 patients
Psychiatric diagnostic evaluation 90791
A psychiatric diagnostic evaluation is a thorough assessment used to identify any mental health conditions you may have. It involves a detailed discussion about your symptoms, thoughts, feelings and behavior patterns. Your medical history and family's mental health history are also considered.
20 services20 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 21617 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $57.99 – $175.57
Typical copayment $0.00 (range $14.49 – $43.89)
Most-billed visit code NA
Established Patient
$72.23 typical visit price
range $18.66 – $143.02
Typical copayment $18.05 (range $4.66 – $35.75)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSEPH C TITUS LCSW-C
Social Worker (Clinical)
120 BANJO LANE
CENTREVILLE, MD 21617
Queen Anne's County (410) 758-2211

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Domino's NPI number?

The NPI number for Mary Domino is 1760666424. It was assigned to this individual provider in the NPPES registry on December 18, 2007. The provider is also known as Mrs. Mary Elizabeth Hall Lcsw-C.

Where is Mary Domino located?

Mary Domino practices at 120 Banjo Lane, Centreville, MD 21617. The listed phone number is (410) 758-3050.

What is Mary Domino's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Mary Domino enrolled in Medicare?

Yes. Mary Domino is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Mary Domino was last updated on October 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.