Individual
DR. SAMANTHA DOMINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
3521 NW SAMARITAN DR STE 201, CORVALLIS, OR 97330-4744
(541) 768-5140
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2791
OR
103TB0200X
Cognitive & Behavioral Psychologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2014
Last updated
11/06/2020
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