Active NPI
Beth A Domingue, LCSW
- Clinical Social Worker
- Culver City, CA
National Provider Identifier
1649504465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 85661
- Practice address
- 9808 Venice Blvd Ste 700
Culver City, CA 90232-6824 - Phone
- (310) 945-3350
- Fax
- (310) 840-7023
- NPI assigned
- Sep 25, 2009
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 32872 | CA | |
| Rehabilitation Practitioner | 225400000X | |||
| Clinical Social Worker | 1041C0700X | 85661 | CA | Primary |
Addresses
Primary practice location
9808 Venice Blvd Ste 700
Culver City, CA 90232-6824
Mailing address
9808 Venice Blvd Ste 700
Culver City, CA 90232-6824
Phone (310) 945-3350
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85661 | CA | MD | Clinical Social Worker |
| 32872 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536537600000",
"number": "1649504465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9808 VENICE BLVD STE 700",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902326824",
"telephone_number": "310-945-3350",
"fax_number": "310-840-7023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9808 VENICE BLVD STE 700",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902326824",
"telephone_number": "310-945-3350",
"fax_number": "310-840-7023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUE",
"first_name": "BETH",
"middle_name": "A",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-25",
"last_updated": "2018-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "32872",
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "85661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.