Provider Demographics
NPI:1811716772
Name:DOHERTY, BRYNN KATHLEEN (MSW, LSW)
Entity type:Individual
Prefix:
First Name:BRYNN
Middle Name:KATHLEEN
Last Name:DOHERTY
Suffix:
Gender:
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 MOUNTAIN BOULEVARD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069
Mailing Address - Country:US
Mailing Address - Phone:908-322-9623
Mailing Address - Fax:
Practice Address - Street 1:2204 MORRIS AVENUE
Practice Address - Street 2:SUITE 308
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:732-333-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ018347341041S0200X
NJ44SL07185600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool