Provider Demographics
NPI:1356535843
Name:DOMINGUEZ, DANIEL FONTANEZ JR (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:FONTANEZ
Last Name:DOMINGUEZ
Suffix:JR
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
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Mailing Address - Street 1:884 MULCASTER CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-1758
Mailing Address - Country:US
Mailing Address - Phone:408-299-6785
Mailing Address - Fax:408-298-0192
Practice Address - Street 1:1075 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2244
Practice Address - Country:US
Practice Address - Phone:408-299-6785
Practice Address - Fax:408-298-0192
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CALCS18257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health