Healthcare Provider Details

I. General information

NPI: 1205230455
Provider Name (Legal Business Name): TARA ANN DOHERTY DNP,RN,FNP,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CARLETON ST FL 1
CAMBRIDGE MA
02142-1323
US

IV. Provider business mailing address

630 CONCORD AVE 202
CAMBRIDGE MA
02138
US

V. Phone/Fax

Practice location:
  • Phone: 617-253-1311
  • Fax: 617-258-7742
Mailing address:
  • Phone: 617-373-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number233904
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number233904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: