MEDICARE: LUCY E 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	765	NH

General Provider Information

NPI Number	:	1639471089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY E DOHERTY LICSW

Provider Business Mailing Address
First Line	:	PO BOX 504
Second Line	:
City	:	NEW DURHAM
State	:	NH
Zip	:	03855-0504
Country	:	US
Telephone Number	:	603-759-1491
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 S SHORE RD
Second Line	:
City	:	NEW DURHAM
State	:	NH
Zip	:	03855-2120
Country	:	US
Telephone Number	:	603-759-1491
Fax Number	:

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

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	02/16/2022

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