Organization
PATRICIA DOHERTY, LICSW, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA JUDITH DOHERTY LICSW (PSYCHOTHERAPIST)
(802) 825-6910
Entity
Organization
Contact information
Practice address
1205 NORTH AVE, BURLINGTON, VT 05408-2804
(802) 489-5665
Mailing address
1205 NORTH AVE, BURLINGTON, VT 05408-2804
(802) 489-5665
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
89.0000877
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023503
—
VT
Enumeration date
11/10/2016
Last updated
11/10/2016
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