Provider Demographics
NPI:1841546108
Name:DOHERTY, JOY PENNELLA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:PENNELLA
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4676
Mailing Address - Country:US
Mailing Address - Phone:631-234-2704
Mailing Address - Fax:
Practice Address - Street 1:1 SHADY LN
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4676
Practice Address - Country:US
Practice Address - Phone:631-234-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker