Healthcare Provider Details

I. General information

NPI: 1295116796
Provider Name (Legal Business Name): MARY DOHERTY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY NEUBRANDER

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28922 LORAIN RD STE 100
NORTH OLMSTED OH
44070-4053
US

IV. Provider business mailing address

28922 LORAIN RD STE 100
NORTH OLMSTED OH
44070-4053
US

V. Phone/Fax

Practice location:
  • Phone: 440-345-8265
  • Fax:
Mailing address:
  • Phone: 440-345-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1700371
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE1700371
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: