Provider Demographics
NPI:1477269462
Name:DOMINGUEZ, SOCORRO (LMSW)
Entity Type:Individual
Prefix:
First Name:SOCORRO
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 N LINDA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-3531
Mailing Address - Country:US
Mailing Address - Phone:602-319-8632
Mailing Address - Fax:
Practice Address - Street 1:10165 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4558
Practice Address - Country:US
Practice Address - Phone:480-994-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor