Provider Demographics
NPI:1932084860
Name:BRITTAIN, DOMINIK MAURICE
Entity type:Individual
Prefix:
First Name:DOMINIK
Middle Name:MAURICE
Last Name:BRITTAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GARCIA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1117
Mailing Address - Country:US
Mailing Address - Phone:505-331-7117
Mailing Address - Fax:
Practice Address - Street 1:400 GARCIA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1117
Practice Address - Country:US
Practice Address - Phone:505-331-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician