Individual
KAITLYN DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., LBS
Contact information
Practice address
600 N JACKSON ST STE 203, MEDIA, PA 19063
(484) 444-2285
Mailing address
600 N JACKSON ST STE 203, MEDIA, PA 19063-2574
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH003571
PA
174400000X
Specialist
BH003571
PA
Other
Enumeration date
12/12/2017
Last updated
01/02/2020
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