Provider Demographics
NPI:1912581182
Name:COOK-DOUGHTY, BRIANNA L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:L
Last Name:COOK-DOUGHTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PAUL GORE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-5204
Mailing Address - Country:US
Mailing Address - Phone:978-835-2389
Mailing Address - Fax:
Practice Address - Street 1:80 PAUL GORE ST APT 3
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-5204
Practice Address - Country:US
Practice Address - Phone:978-835-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical