Provider Demographics
NPI:1487993945
Name:LUCY E. DOHERTY LICSW LLC
Entity type:Organization
Organization Name:LUCY E. DOHERTY LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-759-1491
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:NEW DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03855-0504
Mailing Address - Country:US
Mailing Address - Phone:603-759-1491
Mailing Address - Fax:
Practice Address - Street 1:336 S SHORE RD
Practice Address - Street 2:
Practice Address - City:NEW DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03855-2120
Practice Address - Country:US
Practice Address - Phone:603-759-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty