Healthcare Provider Details

I. General information

NPI: 1417860727
Provider Name (Legal Business Name): BEATRIZ PONTES DE LUCENA DOMINGUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPE ST
BRISTOL CT
06010-6374
US

IV. Provider business mailing address

600 CLARK AVE APT 19
BRISTOL CT
06010-4080
US

V. Phone/Fax

Practice location:
  • Phone: 888-793-3500
  • Fax:
Mailing address:
  • Phone: 860-877-7938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10187
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: