Individual
MARYANN DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
4130 SW 113TH AVE, MIAMI, FL 33165-4644
(786) 470-9273
Mailing address
4130 SW 113TH AVE, MIAMI, FL 33165-4644
(786) 470-9273
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
SS 1258
FL
Other
Enumeration date
06/03/2016
Last updated
11/02/2016
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