Individual
MICKAELLE DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
19 W 106TH ST, NEW YORK, NY 10025-3813
(813) 890-8004
(813) 290-9691
Mailing address
19 W 106TH ST APT 2A, NEW YORK, NY 10025-3862
(929) 204-3548
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
012401
NY
2084P0800X
Psychiatry Physician
4766745
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02362536
—
NY
Enumeration date
06/07/2007
Last updated
06/14/2023
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