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General NPI Number Information
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NPI Number | 1366996456
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Entity Type | Individual
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Provider Name | LAURA GAY DOHERTY LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/07/2016
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Last Update Date | 08/07/2016
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Provider Practice Location Address
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Address Line | 41 E 11TH ST 4TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10003-4602
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Country | US
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Telephone | 973-229-6803
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Fax |
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Provider Business Mailing Address
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Address Line | 33 BROADVIEW TER
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City | CHATHAM
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State | NJ
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Zip | 07928-1826
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Country | US
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Telephone | 973-229-6803
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 095394
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License Number State | NY
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