Lauri Dougherty, LICENSED CLINICAL SO

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

005554 Issued in CT

Practice address

140 Captain Thomas Blvd
Suite 205
West Haven, CT 06516-5951

Phone

(203) 444-5159

Fax

(203) 378-4637

NPI assigned

Jul 15, 2014

Last updated

Jul 15, 2014By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1184031700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 PLEASANT HILL RD",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064771116",
            "telephone_number": "203-799-2187",
            "fax_number": "203-378-4637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 CAPTAIN THOMAS BLVD",
            "address_2": "SUITE 205",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065165951",
            "telephone_number": "203-444-5159",
            "fax_number": "203-378-4637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "LAURI",
        "name_prefix": "Mrs.",
        "credential": "LICENSED CLINICAL SO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-15",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "005554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED CLINICAL SOCIAL WORKER",
            "identifier": "005554",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in West Haven, CT
• Providers in West Haven, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.