Provider Demographics
NPI:1306668686
Name:DOUGHTY, EMMA (CCMA)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WHITNEYS WAY
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:ME
Mailing Address - Zip Code:04664-3402
Mailing Address - Country:US
Mailing Address - Phone:207-610-9409
Mailing Address - Fax:
Practice Address - Street 1:39 WHITNEYS WAY
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:ME
Practice Address - Zip Code:04664-3402
Practice Address - Country:US
Practice Address - Phone:207-610-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEQ8F3G5P2374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty