Provider Demographics
NPI:1255404356
Name:DOHENY, JEFFREY THOMAS (LP)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:DOHENY
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 COUNTY ROAD D E
Mailing Address - Street 2:SUITE B
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5353
Mailing Address - Country:US
Mailing Address - Phone:651-748-5019
Mailing Address - Fax:651-773-7591
Practice Address - Street 1:2006 1ST AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2290
Practice Address - Country:US
Practice Address - Phone:763-421-5535
Practice Address - Fax:763-433-0226
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1880103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN48G91DOOtherBLUE CROSS BLUE SHIELD
MN6213176OtherMEDICA
MNHP40372OtherHEALTH PARTNERS