Provider Demographics
NPI:1285797548
Name:DOUGHERTY, WILLIAM FRANCIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FRANCIS
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 W GROVE ST STE 11
Mailing Address - Street 2:WEST GROVE PROFESSIONAL PLAZA
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2079
Mailing Address - Country:US
Mailing Address - Phone:570-207-1529
Mailing Address - Fax:570-972-2364
Practice Address - Street 1:301 W GROVE ST STE 11
Practice Address - Street 2:WEST GROVE PROFESSIONAL PLAZA
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2079
Practice Address - Country:US
Practice Address - Phone:570-207-1529
Practice Address - Fax:570-972-2364
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health