Provider Demographics
NPI:1700629169
Name:DOHERTY, KRISTEN S (LSSW, CPS)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:S
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LSSW, CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PATRICIA AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4018
Mailing Address - Country:US
Mailing Address - Phone:603-686-6854
Mailing Address - Fax:
Practice Address - Street 1:24 FRONT ST STE 100
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2727
Practice Address - Country:US
Practice Address - Phone:603-420-7432
Practice Address - Fax:603-580-2497
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist