Healthcare Provider Details

I. General information

NPI: 1164336590
Provider Name (Legal Business Name): EMILY M DOHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 INDUSTRIAL PARK RD
PLYMOUTH MA
02360-7246
US

IV. Provider business mailing address

38 SOUTH ST APT 1
BRIDGEWATER MA
02324-2547
US

V. Phone/Fax

Practice location:
  • Phone: 877-996-3154
  • Fax:
Mailing address:
  • Phone: 774-571-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: