Provider Demographics
NPI:1811253735
Name:DOHERTY, KATHLEEN (LMT)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 BENEDICT AVENUE
Mailing Address - Street 2:APT 2A
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591
Mailing Address - Country:US
Mailing Address - Phone:914-552-2856
Mailing Address - Fax:
Practice Address - Street 1:483 BENEDICT AVE
Practice Address - Street 2:APT 2A
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5003
Practice Address - Country:US
Practice Address - Phone:914-552-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019688-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist