| Patricia Doherty, Licsw, Plc | |
|
1205 North Ave Burlington VT 05408-2804 | |
| (802) 489-5665 | |
| Not Available |
| Full Name | Patricia Doherty, Licsw, Plc |
|---|---|
| Speciality | Social Worker |
| Location | 1205 North Ave, Burlington, Vermont |
| Authorized Official Name and Position | Patricia Judith Doherty (PSYCHOTHERAPIST) |
| Authorized Official Contact | 8028256910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Patricia Doherty, Licsw, Plc 1205 North Ave Burlington VT 05408-2804 Ph: (802) 489-5665 | Patricia Doherty, Licsw, Plc 1205 North Ave Burlington VT 05408-2804 Ph: (802) 489-5665 |
| NPI Number | 1760924450 |
|---|---|
| Provider Enumeration Date | 11/10/2016 |
| Last Update Date | 11/10/2016 |
| Medicare PECOS PAC ID | 1052696655 |
|---|---|
| Medicare Enrollment ID | O20170322001686 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760924450 | NPI | - | NPPES |
| 1023503 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 89.0000877 (Vermont) | Primary |
| Provider Name | Patricia J Doherty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588838973 PECOS PAC ID: 5193901833 Enrollment ID: I20141126001437 |
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