MEDICARE: MONIQUE NICOLE DOHERTY LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	225794	MA
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1538630538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE NICOLE DOHERTY LICSW

Provider Business Mailing Address
First Line	:	110 N HILLSIDE RD STE 15
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-9727
Country	:	US
Telephone Number	:	413-522-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 N HILLSIDE RD STE 15
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-9727
Country	:	US
Telephone Number	:	413-522-1009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	06/05/2026

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