Provider Demographics
NPI:1164280970
Name:DOMAS, SEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:DOMAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30285 TIMBERIDGE CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5454
Mailing Address - Country:US
Mailing Address - Phone:734-395-8404
Mailing Address - Fax:
Practice Address - Street 1:37450 SCHOOLCRAFT RD STE 110
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1000
Practice Address - Country:US
Practice Address - Phone:734-395-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist