Provider Demographics
NPI:1770284887
Name:DOCHERTY, STEPHEN J
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:J
Last Name:DOCHERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 LINDA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2743
Mailing Address - Country:US
Mailing Address - Phone:818-415-5466
Mailing Address - Fax:
Practice Address - Street 1:4301 WEST MARKHAM
Practice Address - Street 2:SLOT 589
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-364-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist