Active NPI
Paula Lee Domenici, PHD
- Psychologist
- Rockville, MD
National Provider Identifier
1336202928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0810005899
- Practice address
- 11300 Rockville Pike
Suite 602
Rockville, MD 20852-3003 - Phone
- (301) 816-4756
- NPI assigned
- Dec 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 04206 | MD | |
| Psychologist | 103T00000X | 0810005899 | VA | Primary |
| Psychologist | 103T00000X | 04206 | MD | |
| Psychologist | 103T00000X | PSY-19371 | CA |
Addresses
Primary practice location
11300 Rockville Pike
Suite 602
Rockville, MD 20852-3003
Mailing address
1278 Lamplighter Way
Reston, VA 20194
Phone (202) 378-8804
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-19371 | CA | MD | Psychologist |
| 0810005899 | VA | MD | Psychologist |
| 04206 | MD | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1336202928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1278 LAMPLIGHTER WAY",
"city": "RESTON",
"state": "VA",
"postal_code": "20194",
"telephone_number": "202-378-8804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11300 ROCKVILLE PIKE",
"address_2": "SUITE 602",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208523003",
"telephone_number": "301-816-4756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMENICI",
"first_name": "PAULA",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MD",
"license": "04206",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VA",
"license": "0810005899",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "04206",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY-19371",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.