Provider Demographics
NPI:1013989367
Name:LUIGGI, DOMINGO (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:
Last Name:LUIGGI
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 1:1 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1017
Mailing Address - Country:US
Mailing Address - Phone:215-844-1009
Mailing Address - Fax:253-369-3530
Practice Address - Street 1:1 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1017
Practice Address - Country:US
Practice Address - Phone:215-844-1009
Practice Address - Fax:253-369-3530
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007140L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist