Provider Demographics
NPI:1003458183
Name:DOMINGUEZ, RAQUEL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5373 N UNION BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2073
Mailing Address - Country:US
Mailing Address - Phone:710-644-6131
Mailing Address - Fax:
Practice Address - Street 1:5373 N UNION BLVD STE 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2073
Practice Address - Country:US
Practice Address - Phone:719-644-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NLC01103651041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical