Individual provider · NPI-1

Mark A. Dominguez, MA. PSYA

Psychoanalyst · Teaneck, NJ

NPI number1831765320
StatusActive
Last updated in NPPESJun 3, 2021

Details

NPI
1831765320
Entity type
Individual (NPI-1)
Name
Mark A. Dominguez
Credential
MA. PSYA
Sex
Male
Sole proprietor
No
Enumeration date
Jun 3, 2021
Certification date
Jun 3, 2021
Last updated
Jun 3, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
102L00000X Psychoanalyst––Yes

Practice location

800 Catalpa Ave
Teaneck, NJ 07666

Phone 201-641-5648 · Fax 201-440-8580

Mailing address

250 Euclid Ave
Ridgefield Pk, NJ 07660

Phone 201-641-5648 · Fax 201-440-8580

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