| NPI | 1669969861 |
|---|---|
| Former Name | ELISSA H DOUGHERTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 202163) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AR 19-31AP-PL) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2022-01-31 |