Provider Demographics
NPI:1427266840
Name:DOMINGUEZ, ERICA C
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:C
Last Name:DOMINGUEZ
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 1:2121 N BAYSHORE DR APT 905
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5135
Mailing Address - Country:US
Mailing Address - Phone:786-470-6208
Mailing Address - Fax:
Practice Address - Street 1:9380 SW 72ND ST STE B120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5456
Practice Address - Country:US
Practice Address - Phone:305-274-3170
Practice Address - Fax:305-274-4831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH5294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health