Provider Demographics
NPI:1104097286
Name:DOMINGO, JENNIFER I (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:I
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 FOLSOM BLVD # 348
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4608
Mailing Address - Country:US
Mailing Address - Phone:916-513-0468
Mailing Address - Fax:
Practice Address - Street 1:4127 SANTA ROSA AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-3442
Practice Address - Country:US
Practice Address - Phone:916-513-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist