Active NPI
Kevin Richard Dougherty, PH.D.
- Psychologist
- Linwood, NJ
National Provider Identifier
1730200635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 35SI00327200
- Practice address
- 1910 Wabash Ave
Linwood, NJ 08221-1451 - Phone
- (609) 926-9668
- Fax
- (609) 926-4153
- NPI assigned
- Apr 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 35SI00327200 | NJ | Primary |
Addresses
Primary practice location
1910 Wabash Ave
Linwood, NJ 08221-1451
Mailing address
1910 Wabash Ave
Linwood, NJ 08221-1451
Phone (609) 926-9668
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SI00327200 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730200635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1910 WABASH AVE",
"city": "LINWOOD",
"state": "NJ",
"postal_code": "082211451",
"telephone_number": "609-926-9668",
"fax_number": "609-926-4153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 WABASH AVE",
"city": "LINWOOD",
"state": "NJ",
"postal_code": "082211451",
"telephone_number": "609-926-9668",
"fax_number": "609-926-4153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "KEVIN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "35SI00327200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Linwood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.