Healthcare Provider Details

I. General information

NPI: 1750206298
Provider Name (Legal Business Name): JENNIFER DOMEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S COUNTRY CLUB DR STE 34
MESA AZ
85210-6885
US

IV. Provider business mailing address

14614 S 44TH ST
PHOENIX AZ
85044-6005
US

V. Phone/Fax

Practice location:
  • Phone: 480-662-6708
  • Fax: 602-357-4550
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-23167
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: