Provider Demographics
NPI:1124517156
Name:DOMINGUEZ, CAITLYN ELIZABETH (BSW)
Entity type:Individual
Prefix:MS
First Name:CAITLYN
Middle Name:ELIZABETH
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2844
Mailing Address - Country:US
Mailing Address - Phone:916-364-8395
Mailing Address - Fax:
Practice Address - Street 1:7415 HENRIETTA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-5142
Practice Address - Country:US
Practice Address - Phone:916-896-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker