Provider Demographics
NPI:1235899832
Name:PAZ, DOMINIQUE (LSW)
Entity Type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:
Last Name:PAZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 VILLAGE DR S APT B
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2823
Mailing Address - Country:US
Mailing Address - Phone:732-819-1438
Mailing Address - Fax:
Practice Address - Street 1:17 SENIOR ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-8534
Practice Address - Country:US
Practice Address - Phone:732-819-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL065669001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical