NPIMap

Individual provider Active NPI

Linda S. Domiano, L.I.S.A.C.

  • Addiction (Substance Use Disorder) Counselor
  • Mesa, AZ
National Provider Identifier
1508293291
Registry record updated Sep 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LISAC-10774 Issued in AZ
Practice address
32 S Macdonald
Mesa, AZ 85210-1310
Phone
(480) 969-1471
Fax
(480) 264-0687
NPI assigned
Sep 26, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LISAC-10774 AZ Primary

Addresses

Primary practice location

32 S Macdonald
Mesa, AZ 85210-1310

Mailing address

32 S Macdonald
Mesa, AZ 85210-1310
Phone (480) 969-1471

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

LicenseStateTypeSpecialty
LISAC-10774AZMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Holistic Medical Group Past Accepting new patients
TLC/Transitional Living Communities Past Accepting new patients

Organizations & group practices 2

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": "1380153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380153600000",
    "number": "1508293291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 S MACDONALD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852101310",
            "telephone_number": "480-969-1471",
            "fax_number": "480-264-0687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 S MACDONALD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852101310",
            "telephone_number": "480-969-1471",
            "fax_number": "480-264-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMIANO",
        "first_name": "LINDA",
        "middle_name": "S.",
        "credential": "L.I.S.A.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-26",
        "last_updated": "2013-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC-10774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.