Provider Demographics
NPI:1306663117
Name:DOUGHERTY, CATHERINE ROSE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ROSE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 CHESTNUT ST APT 430
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5518
Mailing Address - Country:US
Mailing Address - Phone:908-499-7823
Mailing Address - Fax:
Practice Address - Street 1:2600 N AMERICAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3413
Practice Address - Country:US
Practice Address - Phone:215-203-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030701363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health