Mickaelle Dougherty, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

012401 Issued in NY

Practice address

19 W 106TH St
New York, NY 10025-3813

Phone

(813) 890-8004

Fax

(813) 290-9691

NPI assigned

Jun 7, 2007

Last updated

Jun 14, 2023By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Integrative Medical Care PC

  • Specialist
  • Castleton, NY
  • NPI 1275533895
  NPD (past)
• R.P.P., Inc.

  • Clinical Psychologist
  • Jackson Heights, NY
  • NPI 1306933767
  NPD (past)

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1477756492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 W 106TH ST APT 2A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253862",
            "telephone_number": "929-204-3548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 W 106TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253813",
            "telephone_number": "813-890-8004",
            "fax_number": "813-290-9691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "MICKAELLE",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-07",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "012401",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "4766745",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02362536",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gillian Alice Dougherty
• James Bernard Dougherty Jr., MD
• Kim Dougherty, PTA
• Max Logan Dougherty, MD, PHD
• Megan Dougherty, LCSW
• Shawn Dougherty, LMSW
• Veronica Dougherty
• Bongi Nkyru Doughty
• Douglas a Schwartz, D.O., P.C. Eastside Medical Group
• Douglas Allen, DO PC

• Psychologist in New York, NY
• Providers in New York, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.