Individual
MR. JOHN ANTHONY DEDOMENICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S. MFT
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
MFC 30336
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30097
BIS
CA
Enumeration date
01/26/2007
Last updated
07/08/2007
Update your record
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