Tannia Carolina Dominguez, MA, LPC

Key facts

NPI

1366324972

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

License

37PC00957600 (NJ)

Practice address

2 Bradford PL
Iselin, NJ 08830-1328

Phone

(908) 930-8617

NPI assigned

Jul 24, 2025

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Arts

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 24, 2025.

{
    "created_epoch": "1753315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1366324972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 BRADFORD PL",
            "city": "ISELIN",
            "state": "NJ",
            "postal_code": "088301328",
            "telephone_number": "908-930-8617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BRADFORD PL",
            "city": "ISELIN",
            "state": "NJ",
            "postal_code": "088301328",
            "telephone_number": "908-930-8617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "TANNIA",
        "middle_name": "CAROLINA",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-24",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37PC00957600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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