Provider Demographics
NPI:1942526116
Name:DOMENITZ, LINDA B (LMFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:B
Last Name:DOMENITZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:860-586-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000424101YP2500X
FLMT3565106H00000X
CT000402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional