Provider Demographics
NPI:1558585570
Name:DOMINGUEZ, CARMEN S (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:S
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-1730
Mailing Address - Country:US
Mailing Address - Phone:781-626-0113
Mailing Address - Fax:
Practice Address - Street 1:386 RIDGE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-1730
Practice Address - Country:US
Practice Address - Phone:781-626-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health