Provider Demographics
NPI:1033756739
Name:DOMINGUEZ GONZALEZ, YANELA
Entity type:Individual
Prefix:
First Name:YANELA
Middle Name:
Last Name:DOMINGUEZ GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 NW SAYERS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-5336
Mailing Address - Country:US
Mailing Address - Phone:786-312-0297
Mailing Address - Fax:
Practice Address - Street 1:1645 PALM BEACH LAKES BLVD STE 1200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2214
Practice Address - Country:US
Practice Address - Phone:561-247-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2025-11-04
Deactivation Date:2025-09-06
Deactivation Code:
Reactivation Date:2025-10-24
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker