Provider Demographics
NPI:1386368645
Name:DOUGHTY, EILEEN FRANCINE (MHC)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:FRANCINE
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NY 111
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-920-8306
Mailing Address - Fax:631-920-8466
Practice Address - Street 1:11 NY 111
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1178
Practice Address - Country:US
Practice Address - Phone:631-920-8306
Practice Address - Fax:631-920-8466
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health