Individual
MRS. ALISA MARY DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
705 MOUNT AUBURN ST, WATERTOWN, MA 02472
(857) 304-8401
Mailing address
160 SUMMER ST, MAYNARD, MA 01754-1056
(978) 495-1899
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
117705
MA
1041C0700X
Clinical Social Worker
CSW7213
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/14/2007
Last updated
08/13/2018
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