Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 003961 | CT |
Y | 103T00000X | Psychologist | 003961 | CT |
NPI | 1003413493 |
---|---|
Provider Name | Dr. Dominica B Hernandez |
First Address | Columbia, CT 06237-1405 |
Second Address | Columbia, CT 06237-1405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2020 |
Last Update Date | 08/10/2020 |