Individual
DR. KEVIN ANTHONY DOMINGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1854 RIVER ST, BOSTON, MA 02136-1419
(617) 364-4465
(617) 364-5425
Mailing address
1854 RIVER ST, BOSTON, MA 02136-1419
(617) 364-4465
(617) 364-5425
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6878
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0524689
—
MA
Enumeration date
11/04/2006
Last updated
07/08/2007
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