Basic Information
| Provider Information | |||||||||
| NPI: | 1629321948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOMBROWSKI | ||||||||
| FirstName: | JAIME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 E HILLCREST ST | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327012713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213059746 | ||||||||
| FaxNumber: | 4075224671 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 MERCY DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328085646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078753700 | ||||||||
| FaxNumber: | 4075224671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2012 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.