Healthcare Provider Details

I. General information

NPI: 1093692352
Provider Name (Legal Business Name): PATRICK B DOHERTY LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 HIGHWAY 187
HATCH NM
87937-7001
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937-0370
US

V. Phone/Fax

Practice location:
  • Phone: 575-267-3088
  • Fax:
Mailing address:
  • Phone: 575-267-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0848
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: