Provider Demographics
NPI:1134090178
Name:DOMINGUEZ CANOSA, STEPHANY DE JESUS
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:DE JESUS
Last Name:DOMINGUEZ CANOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 HEMINGWAY LN E APT 1507
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-5081
Mailing Address - Country:US
Mailing Address - Phone:239-431-0164
Mailing Address - Fax:
Practice Address - Street 1:5271 HEMINGWAY LN E APT 1507
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-5081
Practice Address - Country:US
Practice Address - Phone:239-431-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-472050106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician