Provider Demographics
NPI:1699579730
Name:KELLY DAUGHERTY, LCSW, PLLC
Entity type:Organization
Organization Name:KELLY DAUGHERTY, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-219-8625
Mailing Address - Street 1:118 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2120
Mailing Address - Country:US
Mailing Address - Phone:518-219-8625
Mailing Address - Fax:518-309-6599
Practice Address - Street 1:100 SARATOGA VILLAGE BLVD STE 21
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3703
Practice Address - Country:US
Practice Address - Phone:518-219-8625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty