Healthcare Provider Details

I. General information

NPI: 1588838973
Provider Name (Legal Business Name): PATRICIA JUDITH DOHERTY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA JUDITH LAWAICH MSW

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 CHERRY ST
BURLINGTON VT
05401-3817
US

IV. Provider business mailing address

58 DUGWAY RD
WAITSFIELD VT
05673-6116
US

V. Phone/Fax

Practice location:
  • Phone: 866-843-1722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000877
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: