Active NPI
Eleanor Louise Dougherty, LMSW-C/M.DCSW
- Clinical Social Worker
- Escanaba, MI
National Provider Identifier
1295715498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801069892
- Practice address
- 1341 N 26TH St
Penstar Office Center Ste 103
Escanaba, MI 49829-2515 - Phone
- (906) 233-9588
- Fax
- (906) 217-2008
- NPI assigned
- Jan 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 6801069892 | MI | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3446- 123 | WI | |
| Mental Health Counselor | 101YM0800X | 6801069892 | MI | |
| Mental Health Counselor | 101YM0800X | 3446- 123 | WI | |
| Professional Counselor | 101YP2500X | 6801069892 | MI | |
| Professional Counselor | 101YP2500X | 3446- 123 | WI | |
| Clinical Social Worker | 1041C0700X | 6801069892 | MI | Primary |
| Clinical Social Worker | 1041C0700X | 3446-123 | WI | |
| Marriage & Family Therapist | 106H00000X | 6801069892 | MI |
Addresses
Primary practice location
1341 N 26TH St
Penstar Office Center Ste 103
Escanaba, MI 49829-2515
Mailing address
1341 N 26TH St
Penstar Office Center Ste 103
Escanaba, MI 49829-2515
Phone (906) 233-9588
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 170082-000 | Other | MAGELLAN INDIVIDUAL ID | |
| 0897996 | Other | MI | BCBSM PIN |
| 8008979960 | Other | MI | BCBSM PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3446- 123 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 3446-123 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262822400000",
"number": "1295715498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1341 N 26TH ST",
"address_2": "PENSTAR OFFICE CENTER STE 103",
"city": "ESCANABA",
"state": "MI",
"postal_code": "498292515",
"telephone_number": "906-233-9588",
"fax_number": "906-217-2008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1341 N 26TH ST",
"address_2": "PENSTAR OFFICE CENTER STE 103",
"city": "ESCANABA",
"state": "MI",
"postal_code": "498292515",
"telephone_number": "906-233-9588",
"fax_number": "906-217-2008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "ELEANOR",
"middle_name": "LOUISE",
"credential": "LMSW-C/M.DCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-23",
"last_updated": "2010-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MI",
"license": "6801069892",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "3446- 123",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6801069892",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "3446- 123",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6801069892",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "3446- 123",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801069892",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "3446-123",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MI",
"license": "6801069892",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN INDIVIDUAL ID",
"identifier": "170082-000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM PIN",
"identifier": "0897996",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM PIN",
"identifier": "8008979960",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Escanaba, MI
- DLP Marquette General Hospital LLC (UP Health System Home Care and Hospice)
- DLP Marquette Physician Practices Inc (Doctors Park Family Physicians - Escanaba)
- DLP Marquette Physician Practices Inc (UP Health System Family Medicine)
- Donald J. Pfotenhauer DDS PC
- Steven A Dosh, MD
- Dr Crowes Lighthouse Chiropractic
- Dr Crowes Lighthouse Chiropractic
- Dr Paul J Jacobs DDS PC (RestUp Sleep)
- Rebecca Catherine Dubord
- Annette E Dufour, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.