MEDICARE: CYNTHIA S DAUGHERTY PSYD

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	103TC0700X	Clinical Psychologist	870	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	841170055 80111 A001	OTHER	CO	TRICARE -TRIWEST MILITARY

General Provider Information

NPI Number	:	1437273349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA S DAUGHERTY PSYD

Provider Business Mailing Address
First Line	:	6087 S QUEBEC ST
Second Line	:	STE 103
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4539
Country	:	US
Telephone Number	:	303-770-1975
Fax Number	:	303-469-7375

Provider Business Practice Location Address
First Line	:	6087 S QUEBEC ST
Second Line	:	STE 103
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4539
Country	:	US
Telephone Number	:	303-770-1975
Fax Number	:	303-469-7375

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	03/06/2009

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