Active NPI
Nicole Leann Dominguez, LCSW
- Clinical Social Worker
- San Jose, CA
National Provider Identifier
1437700200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 91221
- Practice address
- 2425 Samaritan Dr
San Jose, CA 95124-3908 - Phone
- (408) 824-3922
- NPI assigned
- Sep 24, 2019
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 91221 | CA | Primary |
Addresses
Primary practice location
2425 Samaritan Dr
San Jose, CA 95124-3908
Mailing address
2425 Samaritan Dr
San Jose, CA 95124-3908
Phone (408) 824-3922
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 91221 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- nicoledominguez@tdh.allscriptsdirect.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580428800000",
"number": "1437700200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2425 SAMARITAN DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951243908",
"telephone_number": "408-824-3922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 SAMARITAN DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951243908",
"telephone_number": "408-824-3922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "NICOLE",
"middle_name": "LEANN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-24",
"last_updated": "2020-01-31",
"certification_date": "2020-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "91221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.