Healthcare Provider Details

I. General information

NPI: 1518215508
Provider Name (Legal Business Name): JOSIAH STEVEN DOMAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3457 MCHENRY AVE STE B
MODESTO CA
95350-1445
US

IV. Provider business mailing address

3457 MCHENRY AVE STE B
MODESTO CA
95350-1445
US

V. Phone/Fax

Practice location:
  • Phone: 209-400-6059
  • Fax: 209-210-4037
Mailing address:
  • Phone: 209-400-6059
  • Fax: 209-210-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29241
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: