Mary Katherine Doherty, LICSW

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

110642 Issued in MA

Practice address

54 Plymouth Ave
Swampscott, MA 01907-1143

Phone

(781) 710-3420

NPI assigned

Aug 27, 2018

Last updated

Aug 27, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 13, 2024 through Feb 13, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mary K Doherty Licsw& Maura Pilotte Licsw Counseling LLC

  • Community/Behavioral Health Agency
  • Salem, MA
  • NPI 1538816863
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535328000000",
    "number": "1124509203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 PLYMOUTH AVE",
            "city": "SWAMPSCOTT",
            "state": "MA",
            "postal_code": "019071143",
            "telephone_number": "781-710-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 PLYMOUTH AVE",
            "city": "SWAMPSCOTT",
            "state": "MA",
            "postal_code": "019071143",
            "telephone_number": "781-710-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-27",
        "last_updated": "2018-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MA",
            "license": "110642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diba Dastjerdi
• Timothy P Difrancesco, DPT PT
• Dutrochet Djoko, PHARMD
• John M DO, M.D.
• Jayna Kathryn Doherty, MSW, LICSW
• Rebecca Donnelly, DPT
• Kristin A Donovan, APRN
• Denise Marie Dorgan, RN IBCLC
• Cody Alan Doucette
• Kristy Lee Zinnes Downey, D.C.

• Professional Counselor in Swampscott, MA
• Providers in Swampscott, MA by specialty
• Professional Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.