Provider Demographics
NPI:1932555661
Name:DOUGHERTY, SUSAN LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:31 CAMBRIDGE LN
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3329
Mailing Address - Country:US
Mailing Address - Phone:215-968-5151
Mailing Address - Fax:
Practice Address - Street 1:31 CAMBRIDGE LN
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3329
Practice Address - Country:US
Practice Address - Phone:215-968-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016932103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist