Individual
CAROLINA MAITE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5355 PAGE BLVD, SAINT LOUIS, MO 63112-3414
(314) 361-2222
Mailing address
5355 PAGE BLVD # MO63112, SAINT LOUIS, MO 63112-3414
(314) 361-2222
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942449194
1942449194
MO
Enumeration date
08/10/2020
Last updated
08/10/2020
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