Active NPI
Irene Daboin Dominguez, PH.D.
- Clinical Psychologist
- Atlanta, GA
National Provider Identifier
1649829417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY004248
- Practice address
- 1409 N Highland Ave NE Ste J
Atlanta, GA 30306-3300 - Phone
- (770) 765-2151
- NPI assigned
- Sep 5, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY004248 | GA | Primary |
Addresses
Primary practice location
1409 N Highland Ave NE Ste J
Atlanta, GA 30306-3300
Mailing address
1409 N Highland Ave NE Ste J
Atlanta, GA 30306-3300
Other names 1
- Irene Daboin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 29, 2024 through Oct 29, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY004248 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567641600000",
"number": "1649829417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1409 N HIGHLAND AVE NE STE J",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303063300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1409 N HIGHLAND AVE NE STE J",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303063300",
"telephone_number": "770-765-2151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DABOIN DOMINGUEZ",
"first_name": "IRENE",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-05",
"last_updated": "2019-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY004248",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "IRENE",
"last_name": "DABOIN",
"credential": "PH.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.