| Doctor Name: | SAMANTHA DOMINGO |
| NPI Number: | 1013336510 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. |
| License Number: | |
| Business Practice Address: | 14060 Biscayne Blvd Apt 415 North Miami Beach, FL - 331811559 |
| Business Phone Number: | 9548292493 |
| Business Fax Number: | |
| Mailing Address: | 14060 Biscayne Blvd, Apt 415 NORTH MIAMI BEACH |
| State: | FL |
| Postal Code: | 331811559 |
| Phone Number: | 9548292493 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2014 |
| NPI Last Update Date: | 04/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |