DR. KEVIN ANTHONY DOMINGOS (NPI# 1770662173) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770662173 |
| Entity Type | Individual |
| Full Name | DR. KEVIN ANTHONY DOMINGOS |
| Credential | PH.D. |
| Practice Address |
1854 River St Boston MA 02136-1419 |
| Practice Telephone | 6173644465 |
| Practice Fax Number | 6173645425 |
| Mailing Telephone | 6173644465 |
| Mailing Fax Number | 6173645425 |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 6878 | MA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 0524689 | 05 |
| Street Address |
1854 RIVER ST |
| City | BOSTON |
| State | MA |
| Zip Code | 02136-1419 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952892564 | Dionne Latrice | Counselor | 695 Truman Pwky, Boston, MA 02136 | 2018-05-21 |
| 1134622426 | Light House Behavioral Health and Wellness Center Inc. | Community/Behavioral Health | 1 Westinghouse Plaza, A-216, Boston, MA 02136 | 2018-03-13 |
| 1396168795 | Living Well | Home Health | 53 Oak St, Hyde Park, MA 02136 | 2014-01-22 |
| 1891051074 | Marie Ronique Yilain | Licensed Practical Nurse | 59 Cromwell Rd, Hyde Park, MA 02136 | 2012-04-02 |
| 1033410543 | Stephanie Sabrina Seigle | Counselor | 5 Linden Ave, Hyde Park, MA 02136 | 2010-11-15 |
| 1699075747 | Jeffrey Meisner | Physical Therapist | 188 Providence Street, Boston Pain Clinic, Hyde Park, MA 02136 | 2010-10-22 |
| 1356593743 | Supplemantal Health Care Services | Residential Treatment Facility, Physical Disabilities | 731 Truman Hwy, Hyde Park, MA 02136 | 2008-10-16 |
| 1407023047 | Amy Elizabeth Delaney | Nurse Practitioner | 695 Truman Parkway, Suite 203, Hyde Park Pediatrics, Hyde Park, MA 02136 | 2008-05-13 |
| 1629254263 | Alla Urman | Nurse Practitioner | 1274 Hyde Park Ave, Hyde Park, MA 02136 | 2008-01-14 |
| 1912106980 | Marina Williams | Counselor | 1158 Hyde Park Ave, Hyde Park, MA 02136 | 2007-07-11 |
| Find all providers in zip 02136 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154949873 | Erica Rose Appleman | Clinical Neuropsychologist | 134 Horace St, Boston, MA 02128-1581 | 2020-07-09 |
| 1154870814 | Jessica Pan | Clinical Neuropsychologist | 1 Bowdoin St, 7th Floor, Boston, MA 02114-4201 | 2016-09-22 |
| 1033524913 | Grant Loren Iverson | Clinical Neuropsychologist | Home Base Program, 101 Merrimac Street, 2nd Floor, Boston, MA 02114 | 2014-06-30 |
| 1396175410 | Daniel R. Seichepine | Clinical Neuropsychologist | 725 Albany St # 7b, Boston Medical Center, Boston, MA 02118-2526 | 2013-11-27 |
| 1235566647 | Todd M Solomon | Clinical Neuropsychologist | 72 East Concord Street, B-7800, Boston University School of Medicine, Boston, MA 02118 | 2013-09-30 |
| 1598015984 | Neuropath LLC | Clinical Neuropsychologist | 106 Queensberry St, # 18, Boston, MA 02215-4713 | 2012-09-13 |
| 1619236718 | Justin Centi | Clinical Neuropsychologist | 185 Devonshire St Ste 901b, Boston, MA 02110-1407 | 2012-05-09 |
| 1740513886 | Aparna Rao | Clinical Neuropsychologist | 75 Arlington St, Suite 500, Boston, MA 02116-3936 | 2009-09-08 |
| 1386845998 | Andrea L Piatt | Clinical Neuropsychologist | 321 Columbus Ave Ste 3, Boston, MA 02116-5168 | 2007-05-30 |
| 1417158288 | Robyn Kervick | Clinical Neuropsychologist | 160 Commonwealth Avenue, Suite U3, Boston, MA 02116 | 2007-05-30 |
| Find all providers in BOSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.