Provider Demographics
NPI:1033974597
Name:DOHERTY, EMMA KATHLEEN
Entity Type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:KATHLEEN
Last Name:DOHERTY
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 1:125 LIBERTY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3325
Mailing Address - Country:US
Mailing Address - Phone:978-750-6828
Mailing Address - Fax:978-651-9519
Practice Address - Street 1:125 LIBERTY ST STE 2
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3325
Practice Address - Country:US
Practice Address - Phone:978-750-6828
Practice Address - Fax:978-651-9519
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health