Provider Demographics
NPI:1528384096
Name:CONFORTI, DOMINICK
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:CONFORTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 S PALM CANYON DR
Mailing Address - Street 2:116
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-9344
Mailing Address - Country:US
Mailing Address - Phone:415-205-4988
Mailing Address - Fax:
Practice Address - Street 1:2290 S PALM CANYON DR
Practice Address - Street 2:116
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-9344
Practice Address - Country:US
Practice Address - Phone:415-205-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health