Healthcare Provider Details

I. General information

NPI: 1770759003
Provider Name (Legal Business Name): KELLY L DAUGHERTY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SILSBEE ST
LYNN MA
01901-1404
US

IV. Provider business mailing address

8 SILSBEE ST
LYNN MA
01901-1404
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-0110
  • Fax:
Mailing address:
  • Phone: 781-599-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7867
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: