Provider Demographics
NPI:1942781620
Name:DOMINGUEZ, NERSY (RBT)
Entity Type:Individual
Prefix:
First Name:NERSY
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 PAPAYA RD APT S
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33413-1892
Mailing Address - Country:US
Mailing Address - Phone:561-452-5236
Mailing Address - Fax:
Practice Address - Street 1:5734 PAPAYA RD APT S
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33413-1892
Practice Address - Country:US
Practice Address - Phone:561-452-5236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician