Provider Demographics
NPI:1578783353
Name:KHOURY, DOHA JAMIL (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOHA
Middle Name:JAMIL
Last Name:KHOURY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107
Mailing Address - Country:US
Mailing Address - Phone:860-570-0011
Mailing Address - Fax:860-236-2036
Practice Address - Street 1:45 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-570-0011
Practice Address - Fax:860-236-2036
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0024771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical