Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003326273 |
---|---|
Provider Name | Stephanie Domnitz |
First Address | Towaco, NJ 07082-1442 |
Second Address | Fair Lawn, NJ 07410-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2017 |
Last Update Date | 02/10/2017 |