Provider Demographics
NPI:1861930026
Name:DOHERTY, LAURA MARGARET (MA, LMHC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARGARET
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2532
Mailing Address - Country:US
Mailing Address - Phone:845-304-6711
Mailing Address - Fax:
Practice Address - Street 1:132 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2532
Practice Address - Country:US
Practice Address - Phone:845-304-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY00979601101YM0800X
NY009796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health