Provider Demographics
NPI:1437846524
Name:DOMINGUEZ, DARLENYS ANTONIA (RBT)
Entity Type:Individual
Prefix:
First Name:DARLENYS
Middle Name:ANTONIA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:DARLENYS
Other - Middle Name:ANTONIA
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:911 N MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4520
Mailing Address - Country:US
Mailing Address - Phone:407-350-4037
Mailing Address - Fax:407-350-4871
Practice Address - Street 1:911 N MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4520
Practice Address - Country:US
Practice Address - Phone:407-350-4037
Practice Address - Fax:407-350-4871
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician