Healthcare Provider Details

I. General information

NPI: 1477269462
Provider Name (Legal Business Name): SOCORRO DOMINGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 N 87TH ST STE 304
SCOTTSDALE AZ
85260-3690
US

IV. Provider business mailing address

1607 N LINDA CIR
MESA AZ
85213-3531
US

V. Phone/Fax

Practice location:
  • Phone: 602-768-6374
  • Fax:
Mailing address:
  • Phone: 602-319-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-24023
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: