Provider Demographics
NPI:1902820731
Name:DOHERTY, THOMAS F (PHD, LICSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:SUITE 265
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3441
Mailing Address - Country:US
Mailing Address - Phone:781-762-6141
Mailing Address - Fax:781-762-4713
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 265
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-762-6141
Practice Address - Fax:781-762-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103047103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2010230OtherCIGNA HEALTH CARE
MA2554999000OtherMAGELLAN BEHAVIORAL HEALT
MA761579OtherTUFTS HEALTH CARE
MAS029382OtherCHAMPUS
MAP03730Medicare ID - Type Unspecified
MA2010230OtherCIGNA HEALTH CARE