Provider Demographics
NPI:1568149565
Name:DOUGHER, OLIVIA SCOTT (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:SCOTT
Last Name:DOUGHER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:OLIVIA
Other - Middle Name:SCOTT
Other - Last Name:MANGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1473
Mailing Address - Country:US
Mailing Address - Phone:908-413-2805
Mailing Address - Fax:
Practice Address - Street 1:1235 WHITEHORSE MERCERVILLE RD STE 306
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3810
Practice Address - Country:US
Practice Address - Phone:877-222-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBACB412074103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst