Provider Demographics
NPI:1649988668
Name:DOMINESEY, NANCY CARDOSO
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CARDOSO
Last Name:DOMINESEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2220 KAIWAWALO ST UNIT 1306
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6551
Mailing Address - Country:US
Mailing Address - Phone:540-645-9541
Mailing Address - Fax:
Practice Address - Street 1:91-2220 KAIWAWALO ST UNIT 1306
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6551
Practice Address - Country:US
Practice Address - Phone:540-645-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
HI19106777106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst