Provider Demographics
NPI:1962299560
Name:DOMINGUEZ, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 HARRISON AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-8401
Mailing Address - Country:US
Mailing Address - Phone:929-220-6579
Mailing Address - Fax:
Practice Address - Street 1:1730 HARRISON AVE APT 1E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-8401
Practice Address - Country:US
Practice Address - Phone:929-220-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst