Healthcare Provider Details

I. General information

NPI: 1780598391
Provider Name (Legal Business Name): CHRISTOPHER ANDREW DOHERTY CASAC-T, CRPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PILLING ST
BROOKLYN NY
11207-1610
US

IV. Provider business mailing address

74 GARFIELD PL APT 1R
BROOKLYN NY
11215-2074
US

V. Phone/Fax

Practice location:
  • Phone: 718-602-1000
  • Fax:
Mailing address:
  • Phone: 570-604-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCASAC-T-42039
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-6858
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: