| Martha Dominguez, Lcsw, Lmft, Pllc | |
|
5959 Gateway Blvd W Ste 570 El Paso TX 79925-3395 | |
| (915) 772-1829 | |
| Not Available |
| Full Name | Martha Dominguez, Lcsw, Lmft, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 5959 Gateway Blvd W Ste 570, El Paso, Texas |
| Authorized Official Name and Position | Martha Dominguez (PROVIDER) |
| Authorized Official Contact | 9157721829 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Martha Dominguez, Lcsw, Lmft, Pllc 5959 Gateway Blvd W Ste 570 El Paso TX 79925-3395 Ph: (915) 772-1829 | Martha Dominguez, Lcsw, Lmft, Pllc 5959 Gateway Blvd W Ste 570 El Paso TX 79925-3395 Ph: (915) 772-1829 |
| NPI Number | 1245968106 |
|---|---|
| Provider Enumeration Date | 08/09/2022 |
| Last Update Date | 08/09/2022 |
| Certification Date | 08/09/2022 |
| Medicare PECOS PAC ID | 2163805532 |
|---|---|
| Medicare Enrollment ID | O20220817002423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245968106 | NPI | - | NPPES |
| 1205943537 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Martha Dominguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205943537 PECOS PAC ID: 3274616313 Enrollment ID: I20080212000521 |
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