Provider Demographics
NPI:1558783001
Name:DORIS M. DOMINGUEZ, MSW,LCSW,PA
Entity Type:Organization
Organization Name:DORIS M. DOMINGUEZ, MSW,LCSW,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-772-9681
Mailing Address - Street 1:9010 SW 137 AVE
Mailing Address - Street 2:236
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1408
Mailing Address - Country:US
Mailing Address - Phone:305-772-9681
Mailing Address - Fax:888-505-1224
Practice Address - Street 1:9010 SW 137 AVE
Practice Address - Street 2:236
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1408
Practice Address - Country:US
Practice Address - Phone:305-772-9681
Practice Address - Fax:888-505-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 75551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty