Provider Demographics
NPI:1932845245
Name:GALVEZ, DOMINIC LORENZO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:LORENZO
Last Name:GALVEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 SW 136TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5127
Mailing Address - Country:US
Mailing Address - Phone:305-608-1677
Mailing Address - Fax:
Practice Address - Street 1:5190 NW 167TH ST STE 215
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6338
Practice Address - Country:US
Practice Address - Phone:305-456-4147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11477103TF0200X
MS60-1050103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic