Individual
AMY DOMINIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 FAIRWAY DR STE 102, DEERFIELD BEACH, FL 33441-1817
(877) 418-2976
(866) 500-2186
Mailing address
24252 CONSERVATION WAY AVE, PONCHATOULA, LA 70454-4249
(504) 344-5969
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
LA
Other
Enumeration date
11/21/2022
Last updated
11/21/2022
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