Provider Demographics
NPI:1790988608
Name:DAUGHERTY, MARIANNE LINDAU (LISW)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:LINDAU
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6310
Mailing Address - Country:US
Mailing Address - Phone:814-769-9633
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:717-242-7264
Practice Address - Fax:717-242-7692
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22034241041C0700X
PASW1236261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790988608OtherNPI