Healthcare Provider Details

I. General information

NPI: 1730969668
Provider Name (Legal Business Name): DOMENICA CONNOLLY ADAMSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 10/30/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E SAN JOAQUIN ST STE 102
SALINAS CA
93901-2946
US

IV. Provider business mailing address

627 VISTA DEL MAR DR
APTOS CA
95003-4817
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-5033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: