Provider Demographics
NPI:1033667670
Name:DOMINGUEZ, MARIA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SO LAFAYETTE PARK PLACE 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5400
Mailing Address - Country:US
Mailing Address - Phone:213-252-2100
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:520 S LAFAYETTE PARK PLACE 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-5400
Practice Address - Country:US
Practice Address - Phone:213-252-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT93262106H00000X
CA116894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist