Provider Demographics
NPI:1073641601
Name:DOHERTY, MAUREEN ELIZABETH (MA, LMFT, LPCC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:MA, LMFT, LPCC
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ELIZABETH
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:5400 CONNECTICUT AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1213
Mailing Address - Country:US
Mailing Address - Phone:619-920-3161
Mailing Address - Fax:
Practice Address - Street 1:5400 CONNECTICUT AVE STE 110
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1213
Practice Address - Country:US
Practice Address - Phone:619-920-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1772101YP2500X
CA48602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional