Provider Demographics
NPI:1821364514
Name:DOHERTY, MICHELLE RITA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RITA
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:161 CHERRY ST
Mailing Address - Street 2:VOICES OF SEPTEMBER 11TH
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4827
Mailing Address - Country:US
Mailing Address - Phone:203-966-3911
Mailing Address - Fax:203-966-5701
Practice Address - Street 1:161 CHERRY ST
Practice Address - Street 2:VOICES OF SEPTEMBER 11TH
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4827
Practice Address - Country:US
Practice Address - Phone:203-966-3911
Practice Address - Fax:203-966-5701
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical