Healthcare Provider Details

I. General information

NPI: 1659781144
Provider Name (Legal Business Name): KAYLA DOHERTY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 UNION ST SUITE 200
LAWRENCE MA
01840-1866
US

IV. Provider business mailing address

15 UNION ST SUITE 200
LAWRENCE MA
01840-1740
US

V. Phone/Fax

Practice location:
  • Phone: 978-416-8977
  • Fax: 978-686-2954
Mailing address:
  • Phone: 978-416-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: