| Kintsugi Therapy Services | |
|
1205 Oxford Way Cocoa FL 32922-6445 | |
| (612) 279-8677 | |
| Not Available |
| Full Name | Kintsugi Therapy Services |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1205 Oxford Way, Cocoa, Florida |
| Authorized Official Name and Position | Migdalia Dominguez (FOUNDER) |
| Authorized Official Contact | 6123100424 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kintsugi Therapy Services 1205 Oxford Way Cocoa FL 32922-6445 Ph: (612) 310-0424 | Kintsugi Therapy Services 1205 Oxford Way Cocoa FL 32922-6445 Ph: (612) 279-8677 |
| NPI Number | 1083198741 |
|---|---|
| Provider Enumeration Date | 09/19/2018 |
| Last Update Date | 09/01/2023 |
| Certification Date | 09/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083198741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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