Provider Demographics
NPI:1790999704
Name:SAVINO, DOMINIC DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:DANIEL
Last Name:SAVINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13931 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2223
Mailing Address - Country:US
Mailing Address - Phone:818-489-1743
Mailing Address - Fax:818-909-7992
Practice Address - Street 1:13931 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2223
Practice Address - Country:US
Practice Address - Phone:818-489-1743
Practice Address - Fax:818-909-7992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 25142OtherLICENSE