Provider Demographics
NPI:1396619409
Name:DOHERTY, BREANA (MSW-LP)
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:MSW-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ERIE BLVD APT 321
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2547
Mailing Address - Country:US
Mailing Address - Phone:518-925-6562
Mailing Address - Fax:
Practice Address - Street 1:391 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1491
Practice Address - Country:US
Practice Address - Phone:518-242-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker