Provider Demographics
NPI:1053859546
Name:DOUGHERTY, JANE (LPC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MAIN ST
Mailing Address - Street 2:1
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1027
Mailing Address - Country:US
Mailing Address - Phone:732-800-1557
Mailing Address - Fax:
Practice Address - Street 1:13 MAIN ST
Practice Address - Street 2:1
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720-1027
Practice Address - Country:US
Practice Address - Phone:732-800-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00040100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional