MEDICARE: CYNTHIA DAUGHERTY PSYD PC

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

General Provider Information

NPI Number	:	1568602381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA DAUGHERTY PSYD PC

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	:	303-487-4990
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	:	303-487-4990
Fax Number	:	303-469-7375

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA S DAUGHERTY
Credential	:	PSYD
Telephone Number	:	303-487-4990

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	09/27/2013

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