Provider Demographics
NPI:1518203041
Name:DOHERTY, CHERYL ANN
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
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 1:505 MIDDLESEX TPKE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3578
Mailing Address - Country:US
Mailing Address - Phone:617-257-1269
Mailing Address - Fax:978-215-5220
Practice Address - Street 1:505 MIDDLESEX TPKE UNIT 3
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3578
Practice Address - Country:US
Practice Address - Phone:617-257-1269
Practice Address - Fax:978-215-5220
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health