Provider Demographics
NPI:1487206272
Name:LINDA B DOMENITZ
Entity Type:Organization
Organization Name:LINDA B DOMENITZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMENITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-966-9718
Mailing Address - Street 1:2800 ISLAND BLVD APT 701
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5606
Mailing Address - Country:US
Mailing Address - Phone:860-966-9718
Mailing Address - Fax:
Practice Address - Street 1:21 WYNDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1144
Practice Address - Country:US
Practice Address - Phone:860-966-9718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty