| Kelly Daugherty, Lcsw, Pllc | |
|
100 Saratoga Village Blvd Ste 21 Malta NY 12020-3703 | |
| (518) 219-8625 | |
| Not Available |
| Full Name | Kelly Daugherty, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 100 Saratoga Village Blvd Ste 21, Malta, New York |
| Authorized Official Name and Position | Kelly Daugherty (OWNER) |
| Authorized Official Contact | 5182198625 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Daugherty, Lcsw, Pllc 118 White Rd Ballston Spa NY 12020-2120 Ph: (518) 219-8625 | Kelly Daugherty, Lcsw, Pllc 100 Saratoga Village Blvd Ste 21 Malta NY 12020-3703 Ph: (518) 219-8625 |
| NPI Number | 1699579730 |
|---|---|
| Provider Enumeration Date | 04/01/2025 |
| Last Update Date | 04/03/2025 |
| Certification Date | 04/03/2025 |
| Medicare PECOS PAC ID | 6709300502 |
|---|---|
| Medicare Enrollment ID | O20250414000636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699579730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kelly L Daugherty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265581482 PECOS PAC ID: 7517285976 Enrollment ID: I20180112001683 |
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