Healthcare Provider Details

I. General information

NPI: 1447176433
Provider Name (Legal Business Name): SARAH JEAN DOMINGUEZ MA, ED.S, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

516 BAY AVE
POINT PLEASANT BEACH NJ
08742-2554
US

IV. Provider business mailing address

465 ARLINGTON AVE S
BAYVILLE NJ
08721-3401
US

V. Phone/Fax

Practice location:
  • Phone: 732-575-2317
  • Fax:
Mailing address:
  • Phone: 732-575-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00963500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: