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General NPI Number Information
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NPI Number | 1043937790
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Entity Type | Organization
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Legal Business Name | ON THE MARGINS FAMILY THERAPY & PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 245 KENTUCKY ST STE E
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City | PETALUMA
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State | CA
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Zip | 94952-2877
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Country | US
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Telephone | 415-212-9064
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Fax |
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Provider Business Mailing Address
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Address Line | 245 KENTUCKY ST STE E
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City | PETALUMA
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State | CA
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Zip | 94952-2877
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Country | US
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Telephone | 415-212-9064
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CHIEF EXECUTIVE OFFICER
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Name | DR. DANIELA DOMINGUEZ
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Credential | PSYD
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Telephone | 415-209-5592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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