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NPI Code Detail

MEDICARE: DR. STEVEN H DOMANN PH.D.

MEDICARE: DR. STEVEN H DOMANN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071006204IL
2103TC0700XClinical Psychologist3982AZ

General Provider Information

NPI Number : 1548318892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEVEN H DOMANN PH.D.
Provider Business Mailing Address
First Line : 4545 N 36TH ST
Second Line : SUITE 205
City : PHOENIX
State : AZ
Zip : 85018-3462
Country : US
Telephone Number : 602-824-9309
Fax Number : 602-916-1086
Provider Business Practice Location Address
First Line : 4545 N 36TH ST
Second Line : SUITE 205
City : PHOENIX
State : AZ
Zip : 85018-3462
Country : US
Telephone Number : 602-824-9309
Fax Number : 602-916-1086
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 02/17/2010

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