Healthcare Provider Details

I. General information

NPI: 1336626928
Provider Name (Legal Business Name): MONICA DOMINGUEZ LCSW-C, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONICA DOMINGUEZ, LCSW-C, LLC LCSW-C, LCSW

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 DAY AVE UNIT A
SAN MATEO CA
94403-1790
US

IV. Provider business mailing address

1512 DAY AVE UNIT A
SAN MATEO CA
94403-1790
US

V. Phone/Fax

Practice location:
  • Phone: 443-379-4366
  • Fax:
Mailing address:
  • Phone: 443-379-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23812
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139718
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019045
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933187
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: