Provider Demographics
NPI:1952552226
Name:DOUGHTY, JULIANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JULIANNE
Middle Name:
Last Name:DOUGHTY
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 1:36 EDGAR AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9655
Mailing Address - Country:US
Mailing Address - Phone:631-286-8282
Mailing Address - Fax:631-803-6793
Practice Address - Street 1:36 EDGAR AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719-9655
Practice Address - Country:US
Practice Address - Phone:631-286-8282
Practice Address - Fax:631-803-6793
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082757-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical