Mary Doherty, MS ED/SPEC ED CERT

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

570723 Issued in NY

Practice address

68 Fitchburg St
Bay Shore, NY 11706-4638

Phone

(631) 665-7113

NPI assigned

Jun 19, 2012

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340064000000",
    "number": "1700149291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 FITCHBURG ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117064638",
            "telephone_number": "631-665-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 FITCHBURG ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117064638",
            "telephone_number": "631-665-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "MS ED/SPEC ED CERT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-19",
        "last_updated": "2012-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "570723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Marie Divittorio, RN
• DLJ Spectacles
• Jaclynn DO, MD
• Jannika Dodge Khatami, M.D.
• Jonathan Doering
• Ryan Alexander Doherty
• Brianna Dollard I, LCAT-LP
• Alexandra Dominguez, FNP-BC
• Claudette Marcia Dominique, R.N
• Erin Jane Donohue, MA, LMHC

• Early Intervention Provider Agency in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Early Intervention Provider Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; 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.