Provider Demographics
NPI:1124401229
Name:DOMINI, DANIEL (MCC, THEOLOGYPHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:DOMINI
Suffix:
Gender:M
Credentials:MCC, THEOLOGYPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9299 SW 152ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1776
Mailing Address - Country:US
Mailing Address - Phone:786-250-5161
Mailing Address - Fax:
Practice Address - Street 1:7392 NW 35TH TER STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:305-597-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health