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Individual
ROXANNE M. DOMINGO
Active
Individual
ROXANNE M. DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
16367
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02824404
—
NY
Enumeration date
11/09/2006
Last updated
06/10/2015
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