Provider Demographics
NPI:1871682799
Name:DAUGHERTY, MELISSA HAMMER (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:HAMMER
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-0109
Mailing Address - Country:US
Mailing Address - Phone:814-227-2747
Mailing Address - Fax:814-227-2277
Practice Address - Street 1:22868 ROUTE 68 STE 17
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8566
Practice Address - Country:US
Practice Address - Phone:814-227-2747
Practice Address - Fax:814-227-2277
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA560700OtherVALUE OPTIONS
PA560700OtherVALUE OPTIONS