Doctor Name: | SHAWN DOUGHERTY |
NPI Number: | 1023353653 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS, LADC |
License Number: | 001019 |
Business Practice Address: | 490 Silver Ln East Hartford, CT - 061181100 |
Business Phone Number: | 8605933902 |
Business Fax Number: | |
Mailing Address: | 490 Silver Ln, EAST HARTFORD |
State: | CT |
Postal Code: | 061181100 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/08/2012 |
NPI Last Update Date: | 12/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 001019 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |