Provider Demographics
NPI:1851620595
Name:DOHERTY, JULIE A
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:A,
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, BCBA, LABA
Mailing Address - Street 1:321 FORTUNE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1750
Mailing Address - Country:US
Mailing Address - Phone:508-478-0207
Mailing Address - Fax:
Practice Address - Street 1:321 FORTUNE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:508-478-0207
Practice Address - Fax:508-634-6984
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71103K00000X
MA2927103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst