Healthcare Provider Details

I. General information

NPI: 1871682799
Provider Name (Legal Business Name): MELISSA HAMMER DAUGHERTY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22868 ROUTE 68 STE 17
CLARION PA
16214-8566
US

IV. Provider business mailing address

PO BOX 109
CLARION PA
16214-0109
US

V. Phone/Fax

Practice location:
  • Phone: 814-227-2747
  • Fax: 814-227-2277
Mailing address:
  • Phone: 814-227-2747
  • Fax: 814-227-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014405
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier560700
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerVALUE OPTIONS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: