Active NPI
Maryann Dominguez, M.S.
- School Psychologist
- Miami, FL
National Provider Identifier
1144679812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- SS 1258
- Practice address
- 4130 SW 113TH Ave
Miami, FL 33165-4644 - Phone
- (786) 470-9273
- NPI assigned
- Jun 3, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | SS 1258 | FL | Primary |
Addresses
Primary practice location
4130 SW 113TH Ave
Miami, FL 33165-4644
Mailing address
4130 SW 113TH Ave
Miami, FL 33165-4644
Phone (786) 470-9273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SS 1258 | FL | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478044800000",
"number": "1144679812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4130 SW 113TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331654644",
"telephone_number": "786-470-9273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4130 SW 113TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331654644",
"telephone_number": "786-470-9273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "MARYANN",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-03",
"last_updated": "2016-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "FL",
"license": "SS 1258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.