Michele Judith Dougherty, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS13019 Issued in CA

Practice address

37053 Cherry Street
Suite 204C
Newark, CA 94560-3785

Phone

(510) 739-0942

Fax

(510) 797-6261

NPI assigned

Sep 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Michele Judith Montgomery Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962593020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37053 CHERRY STREET",
            "address_2": "SUITE 204C",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945603785",
            "telephone_number": "510-739-0942",
            "fax_number": "510-797-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37053 CHERRY STREET",
            "address_2": "SUITE 204C",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945603785",
            "telephone_number": "510-739-0942",
            "fax_number": "510-797-6261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "MICHELE",
        "middle_name": "JUDITH",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS13019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELE",
            "last_name": "MONTGOMERY",
            "middle_name": "JUDITH",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Newark, CA
• Providers in Newark, CA by specialty
• Clinical Social Worker in California

• 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.

Verify at the official NPI Registry.