Healthcare Provider Details

I. General information

NPI: 1710037635
Provider Name (Legal Business Name): MICHAEL A DOUGHERTY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 21ST ST
SACRAMENTO CA
95814-5220
US

IV. Provider business mailing address

4417 BELA WAY
CARMICHAEL CA
95608-1259
US

V. Phone/Fax

Practice location:
  • Phone: 916-448-2951
  • Fax: 916-448-8949
Mailing address:
  • Phone: 916-487-0357
  • Fax: 916-487-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: