Ketty Dominguez, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH17812 Issued in FL

Practice address

4580 Pga Blvd Ste 205
Palm Beach Gardens, FL 33418-3920

Phone

(561) 352-6936

NPI assigned

Mar 5, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 25, 2024 through Oct 25, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1144855636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1743 NEWHAVEN POINT LN",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334116609",
            "telephone_number": "561-352-6936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4580 PGA BLVD STE 205",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334183920",
            "telephone_number": "561-352-6936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "KETTY",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-05",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH17812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Dobson
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• William Seth Doerr
• Julia Doherty, M.A., BCBA
• Natalie C Domena, PA
• Dominick a Marino OD PA
• Donna M Laflamme Inc
• Denis Donovan, DPT
• Brenia W Dorismond
• Kesann Kina Dormand

• Mental Health Counselor in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.