Provider Demographics
NPI:1336202928
Name:DOMENICI, PAULA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:LEE
Last Name:DOMENICI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 LAMPLIGHTER WAY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194
Mailing Address - Country:US
Mailing Address - Phone:202-378-8804
Mailing Address - Fax:
Practice Address - Street 1:11300 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 602
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3003
Practice Address - Country:US
Practice Address - Phone:301-816-4756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04206103TC1900X, 103T00000X
VA0810005899103T00000X
CAPSY-19371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling