Provider Demographics
NPI:1346352762
Name:DOMBROW, MAXINE ANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:ANN
Last Name:DOMBROW
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 1:6386 ALVARADO CT STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4907
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:619-229-2333
Practice Address - Street 1:6386 ALVARADO CT STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4907
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:619-229-2333
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist