Provider Demographics
NPI:1164662367
Name:DOMINGUEZ, JUANITA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:JEAN
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 ENBORG CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2645
Mailing Address - Country:US
Mailing Address - Phone:408-885-7855
Mailing Address - Fax:408-885-7854
Practice Address - Street 1:871 ENBORG CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2645
Practice Address - Country:US
Practice Address - Phone:408-885-7855
Practice Address - Fax:408-885-7854
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS97241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical