Provider Demographics
NPI:1205451713
Name:STAMERRA, DOMINIC MICHAEL
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:MICHAEL
Last Name:STAMERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 108TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4146
Mailing Address - Country:US
Mailing Address - Phone:253-693-2626
Mailing Address - Fax:253-302-4223
Practice Address - Street 1:4606 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4146
Practice Address - Country:US
Practice Address - Phone:253-693-2626
Practice Address - Fax:253-302-4323
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician