Provider Demographics
NPI:1770162760
Name:DOHERTY, SEAN TIMOTHY (RN)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:TIMOTHY
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 WASHINGTON ST.
Mailing Address - Street 2:NORTHEAST BEHAVIORAL HEALTH
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930
Mailing Address - Country:US
Mailing Address - Phone:978-412-7341
Mailing Address - Fax:
Practice Address - Street 1:298 WASHINGTON ST.
Practice Address - Street 2:NORTHEAST BEHAVIORAL HEALTH
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930
Practice Address - Country:US
Practice Address - Phone:978-412-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274703163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health