Provider Demographics
NPI:1780148130
Name:DAUGHERTY, TAYLOR (MSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 EVERETT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1244
Mailing Address - Country:US
Mailing Address - Phone:270-217-5750
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR STE 226
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4847
Practice Address - Country:US
Practice Address - Phone:502-896-8006
Practice Address - Fax:502-896-8055
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker