Provider Demographics
NPI:1902087711
Name:DOHERTY, JOAN M (MA LMFT LPC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:M
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:MA LMFT LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 BRODHEAD RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9299
Mailing Address - Country:US
Mailing Address - Phone:610-868-5606
Mailing Address - Fax:
Practice Address - Street 1:3005 BRODHEAD RD
Practice Address - Street 2:SUITE 280
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9299
Practice Address - Country:US
Practice Address - Phone:610-868-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000182101YP2500X
PAMF000034106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional