Provider Demographics
NPI:1881358034
Name:OCASIO-DOMINGUEZ, SAMUEL J (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:J
Last Name:OCASIO-DOMINGUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OLD COLONY LN APT 11
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4415
Mailing Address - Country:US
Mailing Address - Phone:787-453-2407
Mailing Address - Fax:
Practice Address - Street 1:120 CURTIS ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1243
Practice Address - Country:US
Practice Address - Phone:617-627-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist