Provider Demographics
NPI:1275039687
Name:DOMINGUEZ DE ARMAS, MILDREY C
Entity type:Individual
Prefix:
First Name:MILDREY
Middle Name:C
Last Name:DOMINGUEZ DE ARMAS
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 1:217 PALMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8609
Mailing Address - Country:US
Mailing Address - Phone:407-255-3122
Mailing Address - Fax:
Practice Address - Street 1:3508 WINDY WALK WAY APT 207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7343
Practice Address - Country:US
Practice Address - Phone:407-255-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician