Kintsugi Therapy Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

KINTSUGI THERAPY SERVICES

Practice address

1205 Oxford Way
Cocoa, FL 32922-6445

Phone

(612) 279-8677

NPI assigned

Sep 19, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Migdalia Dominguez, LICSWNPI 1114472008

Title

Founder

Phone

(612) 310-0424

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Migdalia Dominguez, LICSW

  • Clinical Social Worker
  • Cocoa, FL
  • NPI 1114472008
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1083198741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 OXFORD WAY",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329226445",
            "telephone_number": "612-310-0424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 OXFORD WAY",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329226445",
            "telephone_number": "612-279-8677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "618 29th Ave N",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554111406",
            "country_code": "US",
            "telephone_number": "612-279-8677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KINTSUGI THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-19",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ",
        "authorized_official_first_name": "MIGDALIA",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "612-310-0424",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.kintsugitherapyservices.com/",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "1205 Oxford Way",
            "city": "Cocoa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329226445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kidspeace Services Inc
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• Kinder Konsulting & Parents Too, Inc.
• Kinder Konsulting & Parents Too, Inc.
• Marcia E King, APRN
• Kristopher Donald Klein, ATC, LAT
• Christopher Knowles
• Denitrius Knowles
• Paula C Knowles
• Amber Hope Knutson

• Clinical Social Worker in Cocoa, FL
• Providers in Cocoa, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.