Provider Demographics
NPI:1043855299
Name:DOHERTY, MEGAN K (LICSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707B KALORAMA RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2623
Mailing Address - Country:US
Mailing Address - Phone:917-842-5591
Mailing Address - Fax:
Practice Address - Street 1:1707B KALORAMA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2623
Practice Address - Country:US
Practice Address - Phone:917-842-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health