Provider Demographics
NPI:1326297136
Name:DOUGHERTY, EDWARD JAMES (EDD, MA, BA)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:EDD, MA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ALPINE PL
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5941
Mailing Address - Country:US
Mailing Address - Phone:732-563-1110
Mailing Address - Fax:732-563-1113
Practice Address - Street 1:152 VOSSELLER AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1828
Practice Address - Country:US
Practice Address - Phone:732-563-1110
Practice Address - Fax:732-563-1113
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S1001199200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist