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General NPI Number Information
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NPI Number | 1346676707
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Entity Type | Individual
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Provider Name | SHARON MARIE DOUGHERTY RN, LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 1250 WILLIAM FLOYD PARKWAY
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City | SHIRLEY
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State | NY
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Zip | 11967
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Country | US
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Telephone | 631-913-3526
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Fax |
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Provider Business Mailing Address
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Address Line | 994 W JERICHO TPKE STE 202
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City | SMITHTOWN
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State | NY
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Zip | 11787-3234
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Country | US
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Telephone | 631-913-3526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R040221
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 3709361
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License Number State | NY
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