Provider Demographics
NPI:1639471089
Name:DOHERTY, LUCY E (LICSW)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:E
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:NEW DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03855-0504
Mailing Address - Country:US
Mailing Address - Phone:603-759-1491
Mailing Address - Fax:
Practice Address - Street 1:336 S SHORE RD
Practice Address - Street 2:
Practice Address - City:NEW DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03855-2120
Practice Address - Country:US
Practice Address - Phone:603-759-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical