1. Home
  2. Directory
  3. California
  4. Berkeley
  5. Psychologist
  6. NPI Profile

MRS. SUSAN DOMINGUEZ PSY24264
NPI 1477709483
Psychologist - Intellectual and Developmental Disabilities in Berkeley, CA

Active since August 09, 2008PECOS Enrolled
3200 ADELINE ST, BERKELEY, CA 94703(510) 601-0203(510) 601-4002 Get Directions Write a Review

NPPES record last updated: February 4, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 4, 2026, Oct 18, 2018 (2 updates tracked since 2018).

About Mrs. Susan Dominguez Psy24264 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. SUSAN DOMINGUEZ PSY24264 (NPI 1477709483) is an individual intellectual and developmental disabilities provider in Berkeley, California, licensed in California (PSY24264) and active in the NPI registry since August 2008. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1477709483
Entity TypeIndividualFemale
Primary Taxonomy103TM1800X
Provider Legal NameMRS. SUSAN DOMINGUEZCredential: PSY24264
Location Address3200 ADELINE STBerkeley, CA 94703-2407
Mailing Address6010 Highway 9 Ste 7Felton, CA 95018-9535 · (831) 515-6817
Phone(510) 601-0203
Fax(510) 601-4002
Sole ProprietorYes
Enumeration DateAugust 9, 2008
Last NPPES UpdateFebruary 4, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 4, 2026
✔ NPI 1477709483 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Intellectual and Developmental DisabilitiesBehavioral Health & Social Service Providers
Taxonomy Code103TM1800X
License✔ Licensed in CA · PSY24264
3200 ADELINE ST, Berkeley, CA 94703
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Susan Dominguez Psy24264 is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Susan Dominguez reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

County Of Santa Clara
30 mi
Clinic/Center
2741 MIDDLEFIELD RD
Palo Alto, CA 94306
  • Reassigned Medicare billing, California enrollment
  • Also billed through NPI 1043354020 (California), NPI 1629301346 (California)
  • 2,460 clinicians in this Medicare group
NPI 1285228080 (408) 885-5000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MINYON T. MCGRIFF MSW
Social Worker
3200 ADELINE ST
BERKELEY, CA 94703
Alameda County (510) 601-4002
VERENICE IVETTE LOPEZ-MEZA
Student in an Organized Health Care Education/Training Program
3200 ADELINE ST
BERKELEY, CA 94703
Alameda County (415) 684-5178
MICHELE GUSSE
Technician, Health Information
3200 ADELINE ST
BERKELEY, CA 94703
Alameda County (510) 601-0203
TIMOTHY DRAIN JR.
Technician, Health Information
3200 ADELINE ST
BERKELEY, CA 94703
Alameda County (510) 601-0203
BRYCE LIEDTKE
Specialist
3200 ADELINE ST
BERKELEY, CA 94703
Alameda County (510) 506-0203
WARNER GRAHAM
Social Worker
3200 ADELINE ST
BERKELEY, CA 94703
Alameda County (510) 601-0203
EUGENIA GUIDI
Counselor (Mental Health)
3200 ADELINE ST
BERKELEY, CA 94703
Alameda County (510) 915-7266
DR. ENI R SCHALL
Psychologist (Clinical)
3200 ADELINE ST
BERKELEY, CA 94703
Alameda County (510) 601-0203

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susan Dominguez's NPI number?

The NPI number for Susan Dominguez is 1477709483. It was assigned to this individual provider in the NPPES registry on August 9, 2008.

Where is Susan Dominguez located?

Susan Dominguez practices at 3200 Adeline St, Berkeley, CA 94703. The listed phone number is (510) 601-0203.

What is Susan Dominguez's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Intellectual and Developmental Disabilities, with taxonomy code 103TM1800X.

Is Susan Dominguez enrolled in Medicare?

Yes. Susan Dominguez is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Susan Dominguez's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Susan Dominguez reassigns Medicare benefits to County Of Santa Clara (Palo Alto, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Susan Dominguez's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Susan Dominguez was last updated on February 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.