Provider Demographics
NPI:1245722578
Name:TURNER DOUGHERTY, ANGELA C
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:TURNER DOUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S JERSEY AVE UNIT 21
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2036
Mailing Address - Country:US
Mailing Address - Phone:631-213-7690
Mailing Address - Fax:
Practice Address - Street 1:100 S JERSEY AVE UNIT 21
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2036
Practice Address - Country:US
Practice Address - Phone:631-213-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2023-03-15
Deactivation Date:2018-06-19
Deactivation Code:
Reactivation Date:2019-04-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist