MEDICARE: JESSICA DAUGHERTY LPC

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	101YP2500X	Professional Counselor	PCCI3527	CA
2	101YP2500X	Professional Counselor	PC010423	PA

General Provider Information

NPI Number	:	1427474253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DAUGHERTY LPC

Provider Business Mailing Address
First Line	:	2540 NEW BUTLER RD
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-3231
Country	:	US
Telephone Number	:	724-654-2776
Fax Number	:	724-657-3203

Provider Business Practice Location Address
First Line	:	2540 NEW BUTLER RD
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-3231
Country	:	US
Telephone Number	:	724-654-2776
Fax Number	:	724-657-3203

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

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	01/26/2023

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