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DR. KEVIN ANTHONY DOMINGOS PH.D.

Clinical Neuropsychologist

Boston, Massachusetts

Provider NPI: 1770662173

Provider Information:
DR. KEVIN ANTHONY DOMINGOS PH.D.
Gender: M
Sole Proprietor


Practice Location:
1854 RIVER ST  BOSTON, MA 02136 US
Tel: 617-364-4465  Fax: 617-364-5425

Business Mailing Address:
1854 RIVER ST  BOSTON, MA 02136 US
Tel: 617-364-4465  Fax: 617-364-5425

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
MA6878

Other Provider Identifiers:

IssuerNumberStateType
0524689MA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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