MEDICARE: DANIEL JOSEPH DOUGHERTY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904002180	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	800001306	OTHER	VA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	263148-000	OTHER	VA	MAGELLAN
2	110311	OTHER	VA	ANTHEM
3	4945131	OTHER	VA	VIRGINIA PREMIER
4	7110641	OTHER	VA	MAMSI
5	085692	OTHER	VA	SENTARA

General Provider Information

NPI Number	:	1548302730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JOSEPH DOUGHERTY LCSW

Provider Business Mailing Address
First Line	:	8203 FREDONIA RD
Second Line	:	GARDEN COTTAGE COUNSELING
City	:	RICHMOND
State	:	VA
Zip	:	23227-1533
Country	:	US
Telephone Number	:	804-264-3047
Fax Number	:	804-264-3047

Provider Business Practice Location Address
First Line	:	8203 FREDONIA RD
Second Line	:	GARDEN COTTAGE COUNSELING
City	:	RICHMOND
State	:	VA
Zip	:	23227-1533
Country	:	US
Telephone Number	:	804-264-3047
Fax Number	:	804-264-3047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	11/19/2014

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